First AD

Second AD

23-year-old male with a known undisclosed disease presents with left elbow pain.


Elbow radiographs demonstrate a small hyperdense, anterior elbow effusion and suggestions of erosion of the medial and lateral epicondyles. There is no evidence of fracture, dislocation or abnormal mineralization.

Sagittal MRI images (T1 and proton density fat suppressed) and gradient localizer images demonstrate a large amount of synovial thickening within the elbow joint. There is predominately low signal that shows “blooming” on localizer view gradient echo sequences. This is characteristic of hemosiderin deposition in the setting of chronic hemorrhagic products. Small areas of subchondral erosions of the epicondyles and a small effusion are also noted. These findings are those of hemophiliac arthropathy.


Hemophiliac arthropathy is a joint disease occurring in patients suffering from hemophilia related to repeated hemarthrosis. Approximately 50 percent of patients with hemophilia will develop severe arthropathy.

Hemophilia is an X-linked recessive disease that affects males resulting in a deficiency in a coagulation factor. Hemoarthrosis may occur spontaneously or from minor trauma. The affected joints are usually the knee, ankle, elbow, shoulder and hip. It is often common for the same joint to be involved repeatedly. In adulthood, hemoarthroses are uncommon, however, proliferative chronically inflamed synovium results as in the above case.

Early imaging findings include joint effusion and hemarthrosis. In later stages there is synovial hyperplasia with hemosiderin deposition, epiphyseal enlargement and severe destructive changes of the joint. MR imaging is useful in identifying the extent of disease, which is instrumental in early treatment planning. Thickened synovium with hemosiderin deposition will have low signal on all MRI sequences and also “bloom” on gradient echo sequences. MRI will also identify the extent of hemosiderin deposition, cartilage destruction, and bone erosions at an early stage. 


Arnold WD, Hilgartner MW. Hemophilic arthropathy. Current concepts of pathogenesis and management. 

Hermann G, Gilbert MS, Abdelwahab IF. Hemophilia: evaluation of musculoskeletal involvement with CT, sonography, and MR imaging. 

Jaganathan S, Gamanagatti S, Goyal A. Musculoskeletal manifestations of hemophilia: imaging features. 

Ng WH, Chu WC, Shing MK, et al. Role of imaging in management of hemophilic patients. 

X-Ray

News

23-year-old male with a known undisclosed disease presents with left elbow pain. 

Image IQ: 23-year-old Male with Elbow Pain

Matthew Minn, MD

James Jelinek, MD