Imaging of musculoskeletal complications of hemophilia

In patients with hemophilia, hemarthrosis often occurs in one or several joints and may progress to a destructive, disabling arthropathy. Treatment includes continuous or on-demand clotting factor replacement and radionuclide or open synovectomy. The radiographic findings of hemophilic arthropathy depend on the stage of disease, the age of the patient at onset, and the joint involved. These findings include joint effusion, soft tissue swelling, epiphyseal overgrowth, subchondral cysts, osseous erosion, and secondary degenerative changes. Magnetic resonance imaging (MRI) is the most accurate imaging modality for assessing hemophilic arthropathy and may have a significant impact on patient management. MRI is anticipated to be useful in documenting early joint changes when treatment may be most effective. Hemophilic pseudotumor is a chronic, encapsulated, hemorrhagic fluid collection that usually destroys bone and may become quite large. Both computed tomography and MRI are useful in determining the extent of this lesion.