Department of Pediatric Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, P.O. Box 347, 00029 HUS, Helsinki, Finland.
Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Pediatr Radiol. 2020 Apr;50(4):509-515. doi: 10.1007/s00247-019-04580-5. Epub 2019 Dec 19.
Intra-articular venous malformations of the knee are an uncommon cause of unilateral knee pain in children. Timely diagnosis is important because lesions with intrasynovial involvement can lead to joint space hemorrhage and secondary cartilage damage.
To describe our tertiary center's experience of diagnostics and typical magnetic resonance imaging (MRI) findings.
A retrospective review of all patients ≤16 years of age managed for intra-articular venous malformations of the knee at our institution between 2002 and 2018.
Of 14 patients (8 male), the mean age at presentation was 6 years (range: 0-14 years). The most common clinical findings were unilateral knee pain (93%), joint swelling (79%), quadriceps atrophy (50%) and a limited range of motion (29%). Cutaneous manifestations were present in four patients (29%). Contrast-enhanced MRI was available in all cases. After initial MRI, a vascular anomaly etiology had been identified in 11 cases (79%), and correctly reported as a venous malformation in 6 (55%). Three patients received entirely different diagnoses (arthritis, tumor or pigmented villonodular synovitis). Three of seven patients with intrasynovial lesions had established chondropathy at diagnosis. Two patients with lesions of the suprapatellar fat pad had intrasynovial involvement that was not visualised on MRI.
Although MRI usually permits the diagnosis, clinical awareness of these lesions is important for optimal imaging, accurate interpretation and timely diagnosis. Involvement of the intrasynovial cavity carries a risk of hemarthrosis and progressive chondropathy that may be underestimated by MRI.
膝关节关节内静脉畸形是儿童单侧膝关节疼痛的罕见原因。及时诊断很重要，因为有滑膜内受累的病变可导致关节间隙出血和继发性软骨损伤。
描述我们的三级中心在诊断和典型磁共振成像（MRI）表现方面的经验。
对 2002 年至 2018 年间在我们机构接受膝关节关节内静脉畸形治疗的所有≤16 岁患者进行回顾性研究。
14 例患者（8 例男性），平均年龄为 6 岁（范围：0-14 岁）。最常见的临床表现为单侧膝关节疼痛（93%）、关节肿胀（79%）、股四头肌萎缩（50%）和运动范围受限（29%）。4 例患者（29%）存在皮肤表现。所有病例均行增强 MRI 检查。初始 MRI 后，11 例（79%）患者确定了血管异常病因，其中 6 例（55%）正确报告为静脉畸形。3 例患者接受了完全不同的诊断（关节炎、肿瘤或色素绒毛结节性滑膜炎）。7 例滑膜内病变患者中有 3 例在诊断时已存在软骨病。2 例髌上脂肪垫病变患者的滑膜内受累在 MRI 上未显示。
尽管 MRI 通常可做出诊断，但对这些病变的临床认识对于优化成像、准确解读和及时诊断很重要。滑膜内受累可导致关节积血和进行性软骨病，而 MRI 可能低估了这种风险。
