43-year-old male with knee swelling in absence of injury

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Case History

43-year-old man with complaint of pain and swelling of the knee for the last three months. No known injury.

Technical Factors

Long- and short-axis fat- and water-weighted images were performed. 1.5T High Field Oval.

Case Findings

A 13cm (CC) x 5.5cm (ML) x 1.5cm (AP) soft tissue lesion is identified in the anterolateral aspect of the knee and distal thigh involving the prepatellar bursa but extending beyond the bursa. The lesion contains T1 hyperintense T2 intermediate to hyperintense components which are most likely representing synovial metaplasia. Differential considerations include complex prepatellar bursitis and Morel-Lavallee lesion. No deep soft tissue involvement is identified. Quadriceps and patellar tendons are unremarkable.
Swelling of the quadriceps fat pad suggestive of impingement. Patellofemoral joint alignment and chondral surfaces are normal. MPFL and lateral patellar retinacula are intact.
Lateral and medial menisci are intact. Mild chondral thinning at the weightbearing surface of medial femoral condyle is noted. Mild degenerative signal is noted in the posterior horn and body of the lateral meniscus. No high grade chondromalacia in the lateral compartment.
ACL PCL MCL and LCL are intact.
Musculature and neurovascular bundles about the knee are normal.
No macrofracture or bony contusion are identified.

Case Conclusion

A 13cm (CC) x 5.5cm (ML) x 1.5cm (AP) complex soft tissue lesion in the anterolateral aspect of the knee and distal thigh involving the prepatellar bursa but extending beyond the bursa. Differential considerations include complex prepatellar hemorrhagic bursitis and Morel-Lavallee lesion. No deep soft tissue involvement. Consider aspiration.
Swelling of the quadriceps fat pad suggestive of impingement.

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