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Synovial Lining Disease

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0:00

Now this has a synovial lining.

0:02

It's a thinner synovial than what we see in the joint here.

0:06

On a contrast enhanced image of a popliteal cyst,

0:10

you do see thin wall enhancement.

0:13

And because this is synovial, all

0:15

of the synovial diseases we see within the articulation

0:19

can also involve the bursa itself.

0:22

So those would include conditions such

0:25

as rheumatoid arthritis, which we see here,

0:28

CPPD arthropathy, gout, PBNS, et cetera.

0:32

This is a patient with the chronic rheumatoid arthritis

0:35

showing you all the synovial thickening, much

0:38

of which is fibrotic.

0:40

Uh, in this particular example, a few sneaky eye, uh,

0:43

across the, the joint that have formed.

0:46

So same spectrum of diseases that you're gonna see

0:49

with arthritis inside the articulation in this patient,

0:54

we have septic arthritis.

0:56

Uh, this was a patient with Coio Mycosis,

0:59

which is a fungal infection endemic to the desert, uh,

1:03

near, uh, San Diego.

1:06

Uh, so we see a few of these every year,

1:08

and, uh, there's nothing specific about it.

1:10

This could be any infection,

1:12

it could be bacterial or tuberculous.

1:15

Uh, but we have synovial thickening.

1:17

I note that it's much thicker in the joint than in the cyst.

1:20

Okay? And again, it reflects the synovium being, uh,

1:25

quite a bit thinner, uh, in the, uh, in the bursa,

1:28

but certainly, uh, significant amount of, uh,

1:31

synovitis related to, uh, to infection.

1:34

And he also had some marginal, uh, erosions,

1:37

a telltale finding, suggesting the presence of, uh, sepsis.

1:41

Uh, this is PBNS. This is the diffuse form.

1:45

And here we can see the low signal, uh,

1:48

masses invading into the hoffa's, uh, fat pad.

1:52

Some of these are likely extracapsular at this point,

1:56

and there are a number of pathways

1:58

by which this can de hiss out of the capsule posteriorly

2:02

to present in the, uh, popliteal fossa

2:05

with characteristic blooming on the gradient echo sequence.

Report

Faculty

Donald Resnick, MD

Professor Emeritus, Department of Radiology

University of California, San Diego

Mini N. Pathria, MD, FRCP(C)

Division Chief, Musculoskeletal Imaging

University of California San Diego

Eric Y. Chang, MD

Adjunct Professor, Radiology

University of California, San Diego

Brady K. Huang, MD

Clinical Professor of Radiology

UC San Diego Medical Center

Tags

Musculoskeletal (MSK)

MRI

Knee