ABSTRACT
Introducción: La malformación vascular venosa de bajo lujo se desarrolla generalmente durante la primera infancia y puede ser una causa poco frecuente de derrame recurrente de larodilla. La clínica, las pruebas de laboratorio y las radiografías suelen ser inespecíficas. Objetivo: Describir una patología infrecuente en pediatría, para enfatizar en la correcta clasificación y sospecha. Caso Clínico: Paciente de 2 años con historia de episodios de derrame articular de la rodilla derecha que requirió múltiples hospitalizaciones y tratamientos antibióticos. Exámenes de laboratorio normales. La radiografía simple de la rodilla no mostró cambios óseos. La resonancia magnética reportó malformación vascular de bajo lujo. Se realizó resección quirúrgica que evidenció lesión vascular entre las fibras musculares del vasto lateral del cuádriceps con extensión hasta la cápsula de la rodilla y disección de las fibras hasta el vasto lateral de la pierna derecha. El estudio histológico fue compatible con malformación vascular de bajo lujo. Ante el hallazgo benigno y la evolución favorable, continuó con tratamiento ambulatorio. Conclusiones: Aunque la malformación vascular de bajo lujo sinovial es una patología poco frecuente en la población pediátrica, debería considerarse la realización de un diagnóstico diferencial en pacientes con aparición repetida de hemartrosis sin historia de coagulopatía ni hemofilia.
Introduction: Low-low vascular malformation, which usually develops during the first stage of infancy, is a rare cause of recurrent effusion of the knee. History, laboratory and X-rays are usually non-specific. Objective: To describe a rare disease in pediatrics, emphasizing the correct classification and suspicion. Case Report: A case is presented of a two-year-old patient with a history of effusion of the right knee who required multiple hospitalizations and antibiotic treatments. Laboratory work-up was normal. Plain X-rays of the knee revealed no bone changes. MR imaging reported low-low vascular malformation. Surgical resection was performed, evidencing vascular lesion among the muscle fibers of the vastus lateralis of quadriceps until the capsule of the knee, as well as dissection of the fibers until the vastus lateralis of the right leg. Histology was consistent with low-low vascular malformation. Due to the benign outcome and favorable evolution, an outpatient management was possible. Conclusions: Although low-low synovial vascular malformation is a rare disease among the pediatric population, it should be considered in the differential diagnosis of patients with repeated hemarthrosis and no history of either coagulopathy or hemophilia.
Subject(s)
Humans , Female , Child, Preschool , Vascular Malformations/diagnosis , Hemangioma/diagnosis , Knee Joint/pathology , Lymphangioma/diagnosis , Synovial Membrane/pathology , Magnetic Resonance Imaging/methods , Diagnosis, Differential , Vascular Malformations/surgery , Hemangioma/surgery , Hemarthrosis/diagnosisABSTRACT
Controversies exist about the value of ultrasound in diagnosing internal knee derangement. This study was conducted to evaluate the efficacy of ultrasonography in diagnosis of internal derangement of the knee by comparing the ultrasound results with the magnetic resonance imaging findings. Forty-four patients clinically presented with suggestive signs and symptoms of internal derangements of the knee joint were examined by both ultrasonography and MR imaging which were reported separately and their results were compared with each others. Ultrasound was found sensitive for detection of knee joint effusion, lipohemoarthrosis, and baker cyst where 100% of cases were diagnosed by US. The sensitivity of ultrasound for detection of meniscal tears was 83.87% with false negative results of 16.12%, while false positive results were encountered in only 4.54% of the examined patients. The sensitivity of ultrasound to detect complete ACL tear was 85.71%, however unsatisfactory results were obtained in detection of partial or chronic ACL tears. Also, fairly high sensitivity of US to detect MCL tear was seen in the current study; approaching 80%. Ultrasonography can be a useful modality in diagnosing internal derangement of the knee; when MR equipments are not available, with fairly high sensitivity in detection of meniscal tears, ACL and collateral ligaments tears
Subject(s)
Humans , Male , Female , Hemarthrosis/diagnosis , Ultrasonography , Magnetic Resonance Imaging , Anterior Cruciate Ligament/injuries , Posterior Cruciate Ligament/injuries , Sensitivity and SpecificityABSTRACT
Two brothers born to same parents were diagnosed with inherited factor X deficiency of severe type. Clinical presentation in both the cases were haemarthrosis. The elder brother was diagnosed in the year 1991 when he was four and half years old. Recently the youngest child in the family also presented with haemarthrosis at age of one and half years. Diagnosis was made by abnormal results of Coagulation factors screening mainly Prothrombin time, Activated partial thromboplastin time, Russell's viper venom test, mixing tests factor X assay. Both the brothers had Factor X activity less than one percent.
Subject(s)
Child, Preschool , Factor X Deficiency/diagnosis , Hemarthrosis/diagnosis , Humans , Infant , Male , PedigreeABSTRACT
Os autores apresentam estudo estatístico realizado em 29 pacientes (30 joelhos) portadores de hemartrose aguda pós-traumática, submetidos a exame clínico sem e com anestesia, artroscopia ou artrotomia, no período de novembro de 1982 a agosto de 1989. Predominaram as lesöes do ligamento cruzado anterior, encontradas em 21 (70//) joelhos (33,3//) parciais e 36,6// totais), vindo a seguir, em ordem de freqüência, lesöes meniscais em 20 joelhos (66,6//) e fraturas osteocondrais em quatro joelhos (13,3//). Conforme a revisäo bibliográfica e os achados das estruturas lesionadas encontradas em nosso estudo, concluímos que a hemartrose aguda pós-traumatica, como sinal clínico, traduz lesäo importante do joelho
Subject(s)
Humans , Male , Female , Adolescent , Adult , Hemarthrosis/etiology , Knee Injuries/complications , Anesthesia , Hemarthrosis/diagnosisABSTRACT
Os autores apresentam estudo estatístico realizado em 50 pacientes (50 joelhos) portadores de hemartrose aguda pós-traumática, submetidos a exame clínico sob anestesia e artroscopia, no período de junho de 1986 a setembro de 1988. Lesäo do ligamento cruzado anterior foi encontrada em 37 (73%) pacientes (59,4%) parciais e 40,5% totais); lesöes meniscais em 17 (34%) e fraturas osteocondrais em 10 pacientes (20%). Baseados em sua experiência e na literatura, concluem: 1) hemartrose pós-traumática traduz lesäo importante do joelho; 2) exame sob anestesia e artroscopia permite diagnóstico mais preciso; 3) hemartrose näo se constitui em contra-indicaçäo absoluta ao procedimento artroscópico
Subject(s)
Adolescent , Adult , Humans , Male , Female , Hemarthrosis/diagnosis , Knee Injuries/complications , Arthroscopy , Hemarthrosis/etiologyABSTRACT
Com base no estudo de 50 pacientes portadores de entorse moderada do joelho com hemartrose, submetidos a exame clínico sob anestesia e artroscopia, os autores chamam a atenção para a potencial gravidade destas lesões, principalmente para a alta incidência de lesão do ligamento cruzado anterior, constatada em 75 por cento dos pacientes.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Sprains and Strains/diagnosis , Hemarthrosis/diagnosis , Knee Injuries/diagnosis , Anterior Cruciate Ligament/injuries , Arthroscopy , Sprains and Strains/complications , Hemarthrosis/etiologyABSTRACT
Se describen los factores que inciden en la formación de una hemartrosis hemofílica, clínica, diagnóstico y tratamiento. Se destaca que todo tratamiento en un hemofílico estará dirigido a evitar las formaciones residuales. En la artropatía hemofílica crónica se desarrolla su fisiopatología, anatomía patológica, sintomatología y radiología. Se presentan 19 casos de operaciones en rodillas hemofílicas realizadas en 20 años, su evolución y resultados