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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
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Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
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For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Practice Cases
Worklist 1
10 topics, 17 min.
Practice Cases
Worklist 2
10 topics, 21 min.
Practice Cases
Worklist 3
10 topics, 28 min.
Practice Cases
Worklist 4
10 topics, 19 min.
Practice Cases
Worklist 5
10 topics, 43 min.
0:00
The clinical history here is bilateral knee pain,
0:05
acute bilateral knee pain in a patient
0:08
with psoriatic arthritis.
0:10
And we can see that there is distension of the
0:14
suprapatellar joint recess with
0:16
fluid large joint effusion.
0:20
The fluid is outlining front like projections of
0:25
thickened synovial folds into the suprapatellar recess.
0:30
And this is in keeping with synovitis,
0:34
synovial proliferation in the setting of
0:38
inflammatory arthropathy. In these patients,
0:41
it's very important to check the margins of the
0:46
articular surfaces for the presence of marginal
0:50
erosions that are typically associated
0:53
with myoedema in the acute setting.
0:56
So this patient does not have
0:59
acute marginal erosions.
1:01
We know that there is bilateral knee pain.
1:03
Both knees have joint effusions.
1:08
So this is an acute setting of psoriatic arthritis.
1:12
Just to emphasize the front like projections
1:16
in the suprapatellar joint space,
1:19
we can see how they are projecting off
1:22
from the lining of the joint space.
1:26
And this is very typical of
1:29
synovitis in this patient.
Wk 2, Case 3 - Review
HIDEInteractive Transcript
0:00
The clinical history here is bilateral knee pain,
0:05
acute bilateral knee pain in a patient
0:08
with psoriatic arthritis.
0:10
And we can see that there is distension of the
0:14
suprapatellar joint recess with
0:16
fluid large joint effusion.
0:20
The fluid is outlining front like projections of
0:25
thickened synovial folds into the suprapatellar recess.
0:30
And this is in keeping with synovitis,
0:34
synovial proliferation in the setting of
0:38
inflammatory arthropathy. In these patients,
0:41
it's very important to check the margins of the
0:46
articular surfaces for the presence of marginal
0:50
erosions that are typically associated
0:53
with myoedema in the acute setting.
0:56
So this patient does not have
0:59
acute marginal erosions.
1:01
We know that there is bilateral knee pain.
1:03
Both knees have joint effusions.
1:08
So this is an acute setting of psoriatic arthritis.
1:12
Just to emphasize the front like projections
1:16
in the suprapatellar joint space,
1:19
we can see how they are projecting off
1:22
from the lining of the joint space.
1:26
And this is very typical of
1:29
synovitis in this patient.
Report
Patient History
Bilateral knee pain in a 28-year-old man.
Findings
Menisci:
Medial Meniscus: Intact.
Lateral Meniscus: Intact.
Ligaments:
Anterior Cruciate Ligament: Intact.
Posterior Cruciate Ligament: Intact.
Medial Collateral Ligament: Intact.
Lateral Collateral Ligament: Intact.
Posterolateral Corner Structures: Intact.
Posteromedial Corner Structures: Intact.
Extensor Mechanism:
Patellar Tendon: Intact.
Distal Quadriceps Tendon: Intact.
Medial Patellofemoral Ligament: Intact.
Medial and Lateral Patellar Retinacula: Thickened lateral retinaculum. Lax medial retinaculum.
Hoffa’s Fat Pad: Superolateral Hoffa’s fat pad edema with subjacent thickening and induration of the infrapatellar plica.
Articulations:
Patellofemoral Compartment: Borderline shallow trochlear groove. Mildly dysplastic Wiberg 2 patella. Patellar lateralization and tilt noted. Diffuse grade 3-4 medial patellar facet chondromalacia, with focal penetrating osteochondral erosions involving the mid medial patellar facet. Lateral patellar facet and trochlear cartilage relatively preserved. Mild osteophytic spurring of the upper and lower pole of the patella.
Medial Compartment: Tiny subchondral pseudocyst anteromedial aspect tibial condylar rim. Otherwise unremarkable.
Lateral Compartment: Normal.
General:
Bones: Early osteophytic spurring of the upper and lower pole of the patella. Tiny subchondral pseudocyst anteromedial aspect medial tibial condylar room. Otherwise unremarkable.
Effusion: Large knee joint effusion with diffuse florid synovitis insinuating into capsular recesses, consistent with known history of psoriatic arthritis.
Baker’s Cyst: None.
Loose Bodies: None.
Soft tissue and neurovascular: Normal. Intact popliteal neurovascular bundle.
Conclusion
1. Active knee joint arthrosynovitis with large knee joint effusion and synovial reaction, compatible with provided history of psoriatic arthritis.
2. Moderate grade chondromalacia patellae, including diffuse grade 3-4 medial patellar chondromalacia with small focal penetrating erosions.
3. Secondary signs of patellar maltracking, on background of lateral patellar tilt and lateralization, and low grade patellar and femoral trochlear dysplasia.
Case Discussion
Faculty
Omer Awan, MD, MPH, CIIP
Associate Professor of Radiology
University of Maryland School of Medicine
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Jenny T Bencardino, MD
Vice-Chair, Academic Affairs Department of Radiology
Montefiore Radiology
Edward Smitaman, MD
Clinical Associate Professor
University of California San Diego
Tags
Musculoskeletal (MSK)
MRI
Knee
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