A 55-year-old Man with Painless Joint Swelling

Abstract

A 55-year-old man presented with swelling of left knee for the past one month. He also complained of episodes of joint locking. There was no history of pain, fever or trauma. Physical examination revealed localized increase in temperature of the skin, a large joint effusion, and decreased range of motion. His total leukocyte count was normal; ESR was raised to 48 mm in the first hour. Antero-posterior and lateral radiograph of the knee revealed large joint effusion with no bony abnormality. Subsequent magnetic resonance imaging (MRI) performed revealed joint effusion with lobulated enhancing synovial masses around the knee joint. The masses appeared low signal on T1 weighted, T2-weighted and Proton density image. “Blooming effect” with marked loss of signal was seen on GRE-DESS image. FNAC and joint aspiration was hemorrhagic. Synovial biopsy was performed and revealed villi and nodule with extensive hemosiderin deposition and abundant multinucleated giant cells.