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Case of the Week 195

Case of the Week 195. 19 year old female with insidious onset of left hip pain and decreased ROM. What are the abnormal findings? What is the diagnosis or differenatial diagnosis? What should be done next?. ANSWERS. Abnormal Findings:

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Case of the Week 195

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  1. Case of the Week 195 19 year old female with insidious onset of left hip pain and decreased ROM.

  2. What are the abnormal findings? What is the diagnosis or differenatial diagnosis? What should be done next?

  3. ANSWERS Abnormal Findings: Multiple calcific densities are noted inferior to the left ischial tuberosity and superolateral to the left acetabulum. Erosion of the superolateral aspect of the left femoral neck is present, giving a so-called ‘apple core’ appearance. Swelling of the psoas and gluteus medius fat planes around the left hip is noted. DX or DDX: 1. Synoviochondrometaplasia (formerly called osteochondromatosis). 2. Pigmented Villonodular synovitis. Next procedure: As there may be many more ‘loose bodies’ around this hip that cannot be seen due to the fact that they are not calcified, an MRI is indicated.

  4. Selected MRI slices are shown (fat suppressed T2-weighted). What are the abnormal findings? What is the most likely Diagnosis? Axial Sagittal Coronal

  5. ANSWERS Coronal Abnormal Findings: Effusion is present within the hip joint (high signal intensity) with numerous areas of low signal intensity discrete ‘bodies’. Most likely Diagnosis: Synoviochondrometaplasia. The numerous low signal intensity ‘lesions’ are the cargilagenous loose bodies or ‘joint mice’ that could not be seen on the routine pelvic radiograph. Sagittal Axial

  6. Additional Information • This rare entity is thought by some to be incited by trauma leading to cartilaginous metaplasia of the synovial intimal cells leading to active synovitis and nodule fomration. Calcification or ossification of these nodules may occur later. • The complete excision of the abnormal synovium (and loose bodies) seems to provide a cure. • Ref: Shivakumarswamy U, Vijay P, et al. Bilateral Primary Synovial chondromatoisis: A Case Report with literature review. Journal of Clinical and Diagnostic Research 2012; 6:475-477.

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