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DOI: 10.1055/s-2003-41346
Imaging of Musculoskeletal Complications of Hemophilia
Publikationsverlauf
Publikationsdatum:
14. August 2003 (online)
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ABSTRACT
In patients with hemophilia, hemarthrosis often occurs in one or several joints and may progress to a destructive, disabling arthropathy. Treatment includes continuous or on-demand clotting factor replacement and radionuclide or open synovectomy. The radiographic findings of hemophilic arthropathy depend on the stage of disease, the age of the patient at onset, and the joint involved. These findings include joint effusion, soft tissue swelling, epiphyseal overgrowth, subchondral cysts, osseous erosion, and secondary degenerative changes. Magnetic resonance imaging (MRI) is the most accurate imaging modality for assessing hemophilic arthropathy and may have a significant impact on patient management. MRI is anticipated to be useful in documenting early joint changes when treatment may be most effective. Hemophilic pseudotumor is a chronic, encapsulated, hemorrhagic fluid collection that usually destroys bone and may become quite large. Both computed tomography and MRI are useful in determining the extent of this lesion.
KEYWORDS
Hemophilia - hemarthrosis - hemophilia - pseudotumor - magnetic resonance imaging - computed tomography
REFERENCES
- 1 Lachiewicz P F. Management of the knee in hemophilia. In: Insall JN, ed. Surgery of the Knee, 2nd ed New York: Churchill Livingstone 1993: 1149-1169
- 2 Roosendaal G, Van Den Berg M H, Lafeber F J G P, Bijlsma J WJ. Blood-induced joint damage: an overview of musculoskeletal research in haemophilia. In: Rodriguez-Merchan EC, Goddard NJ, Lee CA, eds. Musculoskeletal Aspects of Haemophilia Oxford: Blackwell Science 2000: 18-26
- 3 Resnick D. Bleeding disorders. In: Resnick D, ed. Diagnosis of Bone and Joint Disorders Philadelphia: WB Saunders 2002: 2346-2373
- 4 Swanton M. Hemophilic arthropathy in dogs. Lab Invest . 1959; 8 1269-1277
- 5 Rodriguez-Merchan E C. Pathogenesis, early diagnosis, and prophylaxis for chronic hemophilic synovitis. Clin Orthop . 1997; 343 6-11
- 6 Speer D P. Early pathogenesis of hemophilic arthropathy. Evolution of the subchondral cyst. Clin Orthop . 1984; 185 250-265
- 7 Greene W B, McMillan C W, Warren M W. Prophylactic transfusion for hypertrophic synovitis in children with hemophilia. Clin Orthop . 1997; 343 19-24
- 8 Siegel M E, Siegel H J, Luck Jr V J. Radiosynovectomy's clinical applications and cost effectiveness: a review. Semin Nucl Med . 1997; 27 364-371
- 9 Silva M, Luck Jr V J, Siegel M E. 32P chromic phosphate radiosynovectomy for chronic haemophilic synovitis. Haemophilia . 2001; 7 40-49
- 10 Triantafyllou S J, Hanks G A, Handal J A, Greer R B. Open and arthroscopic synovectomy in hemophilic arthropathy of the knee. Clin Orthop . 1992; 283 196-204
- 11 Arnold W D, Hilgartner M W. Hemophilic arthropathy. Current concepts of pathogenesis and management. J Bone Joint Surg . 1977; 59A 287-305
- 12 DePalma A F, Cotler J. Hemophilic arthropathy. Clin Orthop . 1956; 8 163-171
- 13 Pettersson H, Ahlberg A, Nillson I M. A radiologic classification of hemophilic arthropathy. Clin Orthop . 1980; 149 153-159
- 14 Pavlov H, Goldman A B, Arnold W D. Haemophilic arthropathy in the joints of the hands and feet. Br J Radiol . 1979; 52 173-180
- 15 Heim M, Horoszowski H, Martinowitz U, Seligsohn V, Engel J. Haemophilic hands-a three year follow-up study. Hand . 1982; 14 333-336
- 16 Pettersson H, Gilbert M S. Diagnostic Imaging in Hemophilia. Berlin: Springer-Verlag 1985: 23-68
- 17 Zimbler S, McVerry B, Levine P. Hemophilic arthropathy of the foot and ankle. Orthop Clin North Am . 1976; 7 985-997
- 18 Pettersson H, Wingstrand H, Thambert C, Nillson I M, Jonsson K. Legg-Calve-Perthes disease in hemophilia: incidence and etiologic considerations. J Pediatr Orthop . 1990; 10 28-32
- 19 Edeiken J. Roentgen Diagnosis of Diseases of Bone, 3rd ed. Baltimore: Williams & Wilkins; 1981: 587-605
- 20 Wyld P J, Dawson K P, Chisholm R J. Ultrasound in the assessment of synovial thickening in the hemophilic knee. Aust NZ J Med . 1984; 14 678-680
- 21 Kulkarni M V, Drolshagen L F, Kaye J J. et al . MR imaging of hemophilic arthropathy. J Comput Assist Tomogr . 1986; 10 445-449
- 22 Yulish B S, Lieberman J M, Strandjord S E, Bryan P J, Mulopulos G P, Modic M T. Hemophilic arthropathy: assessment with MR imaging. Radiology . 1987; 164 759-762
- 23 Bush C H. The magnetic resonance imaging of musculoskeletal hemorrhage. Skeletal Radiol . 2000; 29 1-9
- 24 Rand T, Trattnig S, Male C. et al . Magnetic resonance imaging in hemophilic children: value of gradient echo and contrast-enhanced imaging. Magn Reson Imag . 1999; 17 199-205
- 25 McCauley T R, Recht M P, Disler D G. Clinical imaging of articular cartilage in the knee. Semin Musculoskelet Radiol . 2001; 5 293-304
- 26 Nagele M, Bruning R, Kunze V, Eickhoff H, Koch W, Reiser M. Hemophilic arthropathy of the knee joint: static and dynamic GD-DTPA-enhanced MRI. Eur Radiol . 1995; 5 547-552
- 27 Idy-Peretti I, Le Balc'h T, Yvart J, Bittoun J. MR imaging of hemophilic arthropathy of the knee: classification and evolution of the subchondral cysts. Magn Reson Imag . 1992; 10 67-75
- 28 Nuss R, Kilcoyne R F, Geraghty S, Wiedel J, Manco-Johnson M. Utility of magnetic resonance imaging for management of hemophilic arthropathy in children. J Pediatr . 1993; 123 388-392
- 29 Plazanet F, du Boullay C, Defaux F. et al . Open synovectomy for the prevention of recurrent hemarthrosis of the ankle in patients with hemophilia. A report of five cases with magnetic resonance documentation. Rev Rheum . 1997; 64 166-171
- 30 Nuss R, Kilcoyne R F, Geraghty S. et al . MRI findings in haemophilic joints treated with radiosynoviorthesis with development of an MRI scale of joint damage. Haemophilia . 2000; 6 162-169
- 31 Gray M L, Burstein D, Xia Y. Biochemical (and functional) imaging of articular cartilage. Semin Musculoskeletal Radiol . 2001; 5 329-343
- 32 Magallon M, Monteagudo J, Altisent C. et al . Hemophilic pseudotumor: multicenter experience over a 25-year period. Am J Hematol . 1994; 45 103-108
- 33 Hermann G, Gilbert M S, Abdelwahab I F. Hemophilia: evaluation of musculoskeletal involvement with CT, sonography, and MR imaging. Am J Roentgenol . 1992; 158 119-123
- 34 Wilson D A, Prince J R. MR imaging of hemophilic pseudotumors. Am J Roentgenol . 1988; 150 349-350
- 35 Jaovisidha S, Ryu K N, Hodler J, Schweitzer M E, Sartoris D J, Resnick D. Hemophilic pseudotumor: spectrum of MR findings. Skeletal Radiol . 1997; 26 468-474