2026, Number 2
Secondary synovial chondromatosis, approach by magnetic resonance
Full text
10.35366/122620
Language: English/Spanish [Versión en español]
References: 5
Page: 147-149
PDF size: 479.28 Kb.
ABSTRACT
Synovial chondromatosis is a rare benign condition. Regarding its epidemiology, the primary form is uncommon, whereas the secondary form is more frequent because it is associated with trauma, osteoarthritis, and osteoarthropathies. It usually affects large joints, such as the knee, which explains its higher prevalence in this population. In our case, we analyzed a female patient with an initial diagnostic impression of gonarthrosis and a sensation of knee locking; subsequently, after reviewing the imaging studies, the diagnosis was confirmed and secondary synovial chondromatosis was established as a secondary diagnosis.INTRODUCTION
Synovial chondromatosis is a benign process that results in the production of multiple metaplastic cartilaginous nodules within the thickness of the connective tissues of tendon sheaths, synovial membrane, and joint bursae,1 typically self-limiting, which can recur locally. However, its histological appearance can suggest a more aggressive chondroid neoplasm (chondrosarcoma), and radiological correlation to localize the process as having a synovial base is vital for a correct diagnosis.2
Synovial chondromatosis has been divided into primary and secondary forms; primary synovial chondromatosis typically affects adults, predominantly men, in the third to fifth decades of life, and the knee is the most commonly affected site. Secondary synovial chondromatosis is associated with joint abnormalities, such as mechanical or arthritic conditions, which cause intra-articular chondral bodies. The disease presents in three phases: synovial metaplasia without loose bodies, coexistence of synovial metaplasia with loose bodies, and loose bodies without the existence of metaplasia in the synovium.3,4
Radiological findings are usually pathognomonic. Findings on magnetic resonance imaging are more variable and depend on the degree of mineralization; however, the most common pattern (77% of cases) shows a low to intermediate signal intensity on T1 and a very high signal intensity on T2, with hypointense calcifications.5
CASE PRESENTATION
A 59-year-old female, with a history of constant sports practice in previous years; currently performs swimming, yoga, and pilates. She reports a history of grade II gonarthrosis and joint effusion on two occasions. Two weeks prior to the study, she presented with pain with functional limitation and a sensation of transient joint locking when leaning on her limb to leave the pool, which is why she came to the institution.
A magnetic resonance imaging study was performed (Figure 1), in which soft tissue swelling and an increased amount of synovial fluid were identified, which appeared heterogeneous, with the presence of internal ovoid images with well-defined borders and low signal intensity on T1 and T2. Involvement is observed in the posterior compartment, posterior to the fibers of the posterior cruciate ligament, posterior to the posterolateral border of the tibia, in the topography of Hoffa's fat, posterior to the lateral femoral condyle, and in the suprapatellar region.
DISCUSSION
Secondary synovial chondromatosis is an increasingly frequently diagnosed entity due to the advancement of non-invasive techniques; in this context, magnetic resonance imaging (MRI) has been considered a fundamental tool, providing critical information regarding intra- or extra-articular localization, the size of the loose bodies, and the presence of reactive synovitis or joint effusion. Furthermore, MRI allows for the identification of signs suggestive of malignant transformation and characterizes the underlying pathology. These findings are essential to assist the clinician in optimizing patient management and establishing a precise correlation between radiology and pathology.
CONCLUSIONS
Magnetic resonance imaging constitutes a non-invasive tool for the diagnosis of secondary synovial chondromatosis and its trigger, with high sensitivity and specificity.
The description of the magnetic resonance imaging characteristics of secondary synovial chondromatosis provides important guidelines that explain the symptoms and guide the clinician toward optimizing management.
There is a strong correlation between the findings described by magnetic resonance imaging and those reported by pathology in the diagnosis of secondary synovial chondromatosis.
REFERENCES
AFFILIATIONS
1 Médico residente de Alta Especialidad en Resonancia Magnética del Sistema Musculoesquelético, Hospital Angeles Pedregal (HAP). Ciudad de México, México.
2 Médico residente de Alta Especialidad en Resonancia Magnética de Cuerpo Completo, HAP. Ciudad de México, México.
3 Médico radiólogo, especialista en Resonancia Magnética. Profesor titular de los Cursos de Alta Especialidad de Resonancia Magnética de Cuerpo Completo y Sistema Musculoesquelético. HAP.
orcid:
4 0000-0002-9697-2167
5 0009-0008-3014-0078
6 0009-0004-4033-0183
7 0000-0001-6793-0171
8 0000-0002-9767-900X
9 0009-0005-3498-5594
If you wish to consult the supplementary data for this article, please contact editorial.actamedica@saludangeles.mx
CORRESPONDENCE
Joana Andrea Rebolledo Casas. Correo electrónico: jhoanacasas@gmail.comReceived: 2024-10-02. Accepted: 2024-10-29.