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Year : 2016  |  Volume : 31  |  Issue : 3  |  Page : 242-243  

Bilateral generalised synovial chondromatosis of the knee: Bone scintigraphic demonstration with radiologic correlation


1 Department of Nuclear Medicine, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
2 Department of Radiology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey

Date of Web Publication7-Jun-2016

Correspondence Address:
Tarik Elri
Department of Nuclear Medicine, School of Medicine, Bulent Ecevit University, Esenkoy, Kozlu, 67600 Zonguldak
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.181860

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   Abstract 


A 67-year-old woman with a history of bilateral progressive knee pain and swelling was referred for 99mTc-methyl diphosphonate bone scintigraphy. Flow and blood pool images showed bilateral heterogeneous increased uptake and delayed phase revealed mass-looking lobulated heterogeneous increased activity in both of knees extending distal part of the femoral shaft, but no other pathologic uptake was found in rest of the body. A.diagnosis of synovial chondromatosis was made when correlated with X-ray and computed tomography.(CT) images. This is a rare presentation of generalized synovial chondromatosis involving both knees which demonstrated on bone scintigraphy with X-ray and CT correlation.

Keywords: Knee, scintigraphy, synovial chondromatosis, Tc-99m-methyl diphosphonate bone scan


How to cite this article:
Elri T, Cabuk M, Salihoglu YS, Erdemir RU, Serifoglu I. Bilateral generalised synovial chondromatosis of the knee: Bone scintigraphic demonstration with radiologic correlation. Indian J Nucl Med 2016;31:242-3

How to cite this URL:
Elri T, Cabuk M, Salihoglu YS, Erdemir RU, Serifoglu I. Bilateral generalised synovial chondromatosis of the knee: Bone scintigraphic demonstration with radiologic correlation. Indian J Nucl Med [serial online] 2016 [cited 2020 Sep 24];31:242-3. Available from: http://www.ijnm.in/text.asp?2016/31/3/242/181860



A 67-year-old woman with a history of bilateral progressive knee pain and swelling for a long while was referred for 99m Tc-methyl diphosphonate (99m Tc-MDP) bone scintigraphy. Flow and blood pool images of three phase 99m Tc-MDP bone scintigraphy demonstrated bilateral heterogeneous increased uptake [Figure 1]. Delayed phase of examination revealed mass-looking lobulated heterogeneous increased activity in both of knees extending distal part of the femoral shaft [Figure 1]e. Subsequently accessed X-ray images of the patient showed multiple irregular calcific densities that forming a conglomerated mass in bilateral periarticular soft tissue [Figure 1]a. Computed tomography (CT) showed bilateral multiple osteochondral lesions in joint space of the knee and surrounding soft tissues suggesting generalized synovial chondromatosis. Bilateral degenerative osteophytic lipping and subchondral cystic erosions in bone ends were also seen [Figure 1].
Figure 1: (a) X-ray (anterior and lateral views) showed multiple irregular calcific densities that forming a conglomerated mass in bilateral periarticular soft tissue. (b) Computed tomography (selected axial slices of distal femur and joint level) showed bilateral multiple osteochondral lesions in joint space of the knee and surrounding soft tissues. Bilateral degenerative osteophytic lipping and subchondral cystic erosions in bone ends were also seen. (c and d) Flow and blood pool images of three-phase bone scintigraphy demonstrated bilateral heterogeneous increased uptake. (e) Delayed phase of examination revealed mass-looking lobulated heterogeneous increased activity in both of knees extending distal part of the femoral shaft

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Synovial chondromatosis is a rare and benign metaplastic condition of synovial membrane characterized by cartilaginous nodules or loose bodies in joint space, bursae, and surrounding soft tissues. This condition frequently presents in middle-aged men and manifests as a single joint involvement. It affects most commonly the knee joint; however, any synovial joints as hip, shoulder, elbow, and temporomandibular joint may be involved. Progressive symptoms may be seen as joint pain, stiffness, and swelling can result in decreased range of motion, osteoarthritic changes, and ultimate immobilization of the joint due to mechanical destruction of cartilage by the loose bodies in untreated cases. Although rare, malignant transformation into chondrosarcoma is noted.[1],[2] Magnetic resonance imaging (MRI) is a useful imaging tool in differentiating chondrosarcoma and other bone tumors but histopathological correlation is required when malignant transformation was suspected.[2],[3] Though routine clinical assessment and conventional radiographic findings are generally sufficient, a CT imaging may need to diagnose in one-third of all cases. CT can detect slight calcification that is not seen with radiography. In routine practice, scintigraphy is usually not performed in the diagnosis of synovial chondromatosis; therefore, there are few reports showing scintigraphic findings of the disease.[4],[5],[6] Normal findings or increased uptake with variable intensities may be seen on flow and blood pool images due to the extent of disease, degree of calcification and inflammation. Delayed phase of scintigraphy commonly shows increased 99m Tc-MDP uptake with variable degrees. Scintigraphic findings must be correlated with CT or MRI to avoid misdiagnosing as malignancy when increased uptake was seen in all phases of 99m Tc-MDP bone scan, especially in single joint involvement.

Bilateral and generalized synovial chondromatosis of the knee is extremely rare, and only a few cases showing radiologic findings of disease has been reported.[7],[8] This is a rare presentation of generalized synovial chondromatosis involving both knees which demonstrated on 99m Tc-MDP bone scintigraphy with X-ray and CT correlation.

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Rangoako ST, Raubenheimer EJ, Mafeelane K. Synovial chondromatosis: A review of the literature and report of two cases. S Afr Orthop J 2015;14:48-51.  Back to cited text no. 1
    
2.
Wittkop B, Davies AM, Mangham DC. Primary synovial chondromatosis and synovial chondrosarcoma: A pictorial review. Eur Radiol 2002;12:2112-9.  Back to cited text no. 2
    
3.
Walker EA, Murphey MD, Fetsch JF. Imaging characteristics of tenosynovial and bursal chondromatosis. Skeletal Radiol 2011;40:317-25.  Back to cited text no. 3
    
4.
Smith R, Hulsey JM. Bone scintigraphic demonstration of synovial chondromatosis. Clin Nucl Med 1987;12:120-2.  Back to cited text no. 4
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5.
Shanley DJ, Evans EM, Buckner AB, Delaplain CB. Synovial osteochondromatosis demonstrated on bone scan: Correlation with CT and MRI. Clin Nucl Med 1992;17:338-9.  Back to cited text no. 5
    
6.
Ayllón L. Synovial chondromatosis with involvement of both knees. Findings on the bone scintigraphy. Rev Esp Med Nucl 2011;30:38.  Back to cited text no. 6
    
7.
Tahmasebi MN, Bashti K, Sobhan M, Ghorbani G. Bilateral synovial knee chondromatosis in a patient with rheumatoid arthritis: Case-report and literature review. Arch Bone Jt Surg 2014;2:260-4.  Back to cited text no. 7
    
8.
Bassir RA, Ismael F, Elbardouni A, Mahfoud M, Berrada MS, Elyaacoubi M. Bilateral synovial chondromatosis in the knee joint with both intra and extra-articular diseases. Pan Afr Med J 2014;19:57.  Back to cited text no. 8
    


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