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| IMAGES IN RHEUMATOLOGY |
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| Ahead of print publication |
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Primary synovial chondromatosis: Ankle joint
Dillibabu Ethiraj, Immanuel Judah Pandiaraj, Venkatraman Indiran
Department of Radio-Diagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| Date of Submission | 17-Jun-2020 |
| Date of Acceptance | 16-Jul-2020 |
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Correspondence Address:
Venkatraman Indiran,
Department of Radio.Diagnosis, Sree Balaji Medical College and Hospital, 7 Works Road,IVR Scans 1, Nellipet Cross Street, Chromepet, Chennai - 600 044, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/injr.injr_156_20
Keywords: Synovial, Chondromatosis, Ankle
A 35-year-old female presented with complaints of pain, swelling, and reduced mobility in the right ankle joint for 3 months with no history of trauma or systemic illness. Her general physical examination and laboratory investigations were unremarkable. Local examination showed a nodular, tender, palpable mass in the right ankle. Restricted range of movements (dorsiflexion up to 15° and plantar flexion up to 20°) was noted. There was no distal neurovascular deficit. Radiograph of the ankle (Oblique and Lateral views) showed a collection of multiple “ring-and-arc” calcified loose bodies along the anterior aspect of ankle with no significant loss of joint space [Figure 1]a and [Figure 1]b. Such an appearance is diagnostic of synovial chondromatosis. A calcaneal spur was also seen. Definitive treatment involves the removal of free fragments and synovectomy, either through arthroscopy or open surgical excision. However, the patient refused to undergo surgical evaluation. | Figure 1: Plain radiograph of the ankle (oblique [a] and lateral [b] views) shows an anterior collection of multiple “ring-and-arc” calcified loose bodies (white arrow) with a calcaneal spur
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Synovial chondromatosis, also known as Reichel's syndrome, is a rare benign arthropathy where there is a metaplastic transformation of synovial tissue into cartilaginous or multiple osteocartilaginous nodules within the bursa, tendinous sheath, and joints. It is classified as primary form (which has unknown etiology) and secondary form (those associated with trauma, degenerative, and neuropathic joint diseases).[1] It is more frequent in men in between 3rd and 4th decades and most commonly occurs in the knee joint (65%), followed by hip (20%), elbow, temporomandibular joints, shoulder, and ankle joint.[2] This case is considered to be the primary form due to spontaneous onset, monoarticular involvement, absence of joint space involvement, and lack of association with any other conditions. Primary synovial chondromatosis of the ankle is a very rare condition with only a few reported in the literature.[3] Plain radiographic examination plays a prime role in the diagnosis of synovial chondromatosis, with calcified loose bodies seen in 70%–95% of cases.[3] The imaging finding of smooth, rounded, “ring-and-arc” calcified bodies within the joint capsule is pathognomonic.[1] As recurrence of synovial chondromatosis at the same location ranges from 3.2% to 22.3% and can lead to malignant transformation, close follow-up is recommended. Differential diagnoses include sesamoid bones, osteochondritis dissecans, synovioma, and pseudogout.[4]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Kumar DS, Ethiraj D, Indiran V, Maduraimuthu P. Bilateral shoulder synovial chondromatosis: Multimodality imaging. Indian J Rheumatol 2019;14:161-2.  [Full text] |
| 2. | Murphey MD, Vidal JA, Fanburg-Smith JC, Gajewski DA. Imaging of synovial chondromatosis with radiologic-pathologic correlation. Radiographics 2007;27:1465-88. |
| 3. | Sedeek SM, Choudry Q, Garg S. Synovial chondromatosis of the ankle joint: Clinical, radiological, and intraoperative findings. Case Rep Orthop 2015;2015:359024. |
| 4. | Neumann JA, Garrigues GE, Brigman BE, Eward WC. Synovial chondromatosis. JBJS Rev 2016;4:e2. |
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