Left Knee Hemarthrosis

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Left Knee Hemarthrosis

Authors, Editors, Case Information Author: Anthony Noll, DO, MHA Affiliation: University of South Alabama Co Author(s): Bishop Carmichael, DO Senior Editor: Jonathan Mason, DO, CAQSM, RMSK Clinical Vignette: A 73-year-old female presented to the Sports Medicine clinic with concerns of left knee effusion, tenderness throughout the joint, and positive McMurray testing following a low-intensity "plant-and-twist" injury 5 days prior. There was a moderate effusion present in the left knee without warmth or erythema appreciated. Type of Probe Used: 4-12 mHz Linear Array Unlabeled Long Axis View of the Suprapatellar Recess Unlabeled Long Axis View of the Suprapatellar Recess Labeled Long Axis View of the Suprapatellar Recess Labeled Long Axis View of the Suprapatellar Recess with heterogenous fluid present slightly proximal to the lateral femoral condyle. Unlabeled Long Axis View of the Suprapatellar Recess Unlabeled Short Axis View of the Suprapatellar Recess Labeled Short Axis View of the Suprapatellar Recess Labeled Short Axis View of the Suprapatellar Recess with heterogenous fluid is appreciated in the joint capsule with the overlying musculotendinous junction of the quadriceps muscle appreciated at the level of the suprapatellar recess. #5 - Video View Video Unlabeled Video of the Left Suprapatellar Recess, Short Axis, Lateral To Medial View #6 - Video View Video This is a Labeled two-second video identifying the dynamic heterogeneous effusion present with sonographic palpation of the lateral suprapatellar recess in short-axis over the femur. Interpretation Image Interpretation: Large complex, heterogeneous, compressible effusion within the suprapatellar recess of the left knee. Ultrasound-guided aspiration 5 days after injury yielded 54 mL of bloody fluid, consistent with subacute hemarthrosis. Teaching Pearl: This is a non-anechoic/heterogenous effusion of the left knee in the setting of injury, and subsequent aspiration of this knee joint yielded 54 cc of bloody fluid. This finding on sonography differs from the common anechoic effusions associated with inflammation/arthritis. The effusion from this case would fit that of a â€œcomplex fluid accumulationâ€ given its mixed echogenicity and intraarticular material displacement with sonopalpation (Nguyen et al., 2018). There is a need to distinguish between inflammatory fluid versus hemarthrosis in the acute injury setting, and ultrasound is a more readily available diagnostic resource given its point-of-care ability. Reference: Nguyen, S., Lu, X., Ma, Y., Du, J., Chang, E. Y., & von Drygalski, A. (2018). Musculoskeletal ultrasound for intra-articular bleed detection: a highly sensitive imaging modality compared with conventional magnetic resonance imaging. Journal of thrombosis and haemostasis : JTH, 16(3), 490â€“499.
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Suprapatellar Recess

Labeled Long Axis View of the Suprapatellar Recess

Unlabeled Long Axis View of the Suprapatellar Recess

Labeled Short Axis View of the Suprapatellar Recess

#5 - Video

#6 - Video

Interpretation

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