Traumatic Knee Lipohemarthrosis

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Traumatic Knee Lipohemarthrosis

Authors, Editors, Case Information Author: Emily Hudspeth, DO Affiliation: Womack Army Medical Center, Fort Bragg, NC Co Author(s): Peter Wikoff, MD Alex Houser, DO, CAQSM, FAAFP Senior Editor: William Denq, MD Clinical Vignette: A 77-year-old female presented to the Emergency Department after sustaining a mechanical ground-level fall with subsequent right knee pain. She was unable to stand or extend her right knee due to pain. Physical exam showed a right knee effusion, inability to perform straight leg raise, limited knee extension due to pain, and tenderness of the patellar tendon and medial and lateral joint lines. Type of Probe Used: 15-4 MHz linear transducer 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 shows a triple-layer complex joint effusion involving hyperechoic fat (F) superficial to intra-articular hemorrhage (arrows) and a gravity-dependent hematocrit level (H). Q, Quadriceps tendon. Unlabeled Short 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 shows a triple-layer complex joint effusion involving hyperechoic fat (F) lateral to intra-articular hemorrhage (arrows) and a gravity-dependent hematocrit level (H). Q, Quadriceps tendon. #5 - Video View Video Long axis cine of the suprapatellar recess from lateral to medial shows a triple-layer complex joint effusion involving hyperechoic fat superficial to intra-articular hemorrhage and a gravity-dependent hematocrit level. Left is proximal, and right is distal. #6 - Video View Video Short axis cine of the suprapatellar recess from distal to proximal and back to distal shows a triple-layer complex joint effusion involving hyperechoic fat lateral to intra-articular hemorrhage and a gravity-dependent hematocrit level. Interpretation Image Interpretation: There is a moderate-to-large, complex joint effusion with triple-layering of superficial hyperechoic fat, an intermediate anechoic layer, and a gravity-dependent heterogeneous red blood cell layer consistent with a lipohemarthrosis. The extensor mechanism, including the quadriceps tendon, patella, and patellar tendon, appears normal without bursal abnormalities. The pre-femoral and quadriceps fat pads are both normal in appearance. Teaching Pearl: A traumatic knee lipohemarthrosis occurs when marrow fat and blood enter the joint space, most often from an intra-articular fracture. Ultrasound can demonstrate the classic layering pattern in the suprapatellar recess, with echogenic fat, anechoic serum, and dependent blood products. This finding should trigger concern for an occult intra-articular fracture when radiographs are unrevealing. Immobilization, weight-bearing precautions, and advanced imaging or orthopedic evaluation are usually appropriate next steps. References: 1. Bianchi S, Zwass A, Abdelwahab IF, Ricci G, Rettagliata F, Olivieri M. Sonographic evaluation of lipohemarthrosis: clinical and in vitro study. J Ultrasound Med. 1995;14(4):279-282. doi:10.7863/jum.1995.14.4.279 2. Bonnefoy O, Diris B, Moinard M, Aunoble S, Diard F, Hauger O. Acute knee trauma: role of ultrasound. Eur Radiol. 2006;16(11):2542-2548. doi:10.1007/s00330-006-0319-x 3. Aponte EM, Novik JI. Identification of lipohemarthrosis with point-of-care emergency ultrasonography: case report and brief literature review. J Emerg Med. 2013;44(2):453-456. doi:10.1016/j.jemermed.2012.07.062 Disclosures: No financial disclosures. The views expressed herein are those of the authors and do not reflect the official policy of the Department of the Army, Defense Health Agency, Department of War, or the U.S. Government.
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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 Short Axis View of the Suprapatellar Recess

Labeled Short Axis View of the Suprapatellar Recess

#5 - Video

#6 - Video

Interpretation

UPCOMING EVENTS

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