Wolfgang Hirsch, S. Horneff (Leipzig/Halle)  

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Leg-Bones  

physical  

After trauma: Swelling in the traumatized joint, no fever, no pain, but a feeling of pressure and decreased range of movement.  

Factor XIII or Factor IX deficiency, in serious cases <1% of the normal value.

After hemorrhage, usually resoprtion, hypertrophy of the synovia, hyperplasia. Possibly widening of the synovia and cartilage.

Hemosiderine deposition in the synovia.

Late findings: Destruction of cartilage. Resorption in the lamella. Cyst formation with hemorrhagic rests, collagen or gelatinous tissue.  

<- view MRI 1

MRI 1: Knee Joint: Hemorrhage with proof of fluid in the suprapatellar recessus. (T2-TIRM sag).




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MRI 2: Knee Joint: T1-SE after contrast with fat saturation: Hypertrophy of the synovia, hyperplasia. Some widening of the synovia onto the cartilage.




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MRI 3: Shoulder Joint: T2-GE. Hemosiderin deposition in the Synovia.




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MRI 4: Knee Joint: T2-TIRM: Late cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue. (Arrows)




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MRI 5: Upper Ankle Joint: T2-TIRM: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




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MRI 6: Elbow: DESS: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




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MRI 7: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




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MRI 8: Knee: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




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MRI 9: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage. The talus on the right side shows small dissicated osteochondrosis.




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MRI 10: Upper Ankle Joint: T1-SE after contrast with fat saturation: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




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MRI 11: Upper Ankle Joint: T2-TIRM: Arthrotic marginal spikes and joint incongruencies.




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MRI 12: T2-GE with FS: Elbow Joint: Metaphyseal widening (due to inflammatory hyperemia)




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MRI 13: Pseudotumor in the soft tissues. T2-TIRM and T1-SE after contrast and fat saturation (arrows)

 

Laboratory diagnostics  

rheumatoid arthritis.  

Even through constant substitution, hemorrhages cause change in the joints after 14 years of age.  

Pettersson-Score (X-Ray 0-13 points)

Osteoporosis
yes: 1

Epiphyseal widening
yes: 1

Irregular subchondral bone surface
incomplete: 1
complete: 2

Joint gap:
Gap > 1mm: 1
Gap < 1mm 2

Subchondral cysts
1 cyst: 1
More than 1 cyst: 2

Erosions of the joint's edges
yes: 1

Incongruence of the joint's edges
slight: 1
increased: 2

Joint deformity (i.e. dislocated)
slight: 1
increased: 2


NUSS-SCORE (MRI 0-13 points):

Hemorrhage
slight: 1
moderate: 2
large: 3

Hemosiderin
present: 1

Synovia hypertrophy
slight: 1
moderate: 2
large: 3

Subchondral cysts/erosion
1 cyst and partial surface erosion: 1
> 1 cyst and partial surface erosion: 2
> 1 cyst and complete surface erosion: 3

Cartilage defects
< 50%: 1
>/= 50%: 2
complete: 3  

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N/A  

hemorrhage, hemophilia, hemophil, hemophilic, arthropathia, arthropathy, hemophilic arthropathy, child, childhood, pediatric radiology  

Wolfgang Hirsch, S Horneff. Hemophilic arthropathy (MRI findings). PedRad [serial online] vol 3, no. 10.
URL: www.PedRad.info/?search=20031026194110