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Post-arthrogram synovitis: MRI and histopathologic findings
Alexander Oserowsky1, Lester J Layfield1, Julia Crim2
1University of Missouri at Columbia, Columbia, MO, USA.
A patient experienced severe joint pain and synovitis after iodinated contrast injection for MR arthrography. This case highlights a severe, albeit likely reactive, inflammatory response to intra-articular contrast.
Area of Science:
- Radiology
- Orthopedic Surgery
- Pathology
Background:
- Iodinated contrast agents are frequently used in medical imaging, including MR arthrography.
- Adverse reactions to intra-articular injections can occur, but severe inflammatory responses are uncommon.
Observation:
- A 57-year-old patient developed severe, persistent pain and new-onset synovitis post-MR arthrography with iodinated contrast.
- Arthroscopy revealed severe synovitis with lymphocytes, neutrophils, and necrosis on histopathology.
- Intraoperative cultures were negative for infection, and inflammatory markers normalized within a month.
Findings:
- The patient's condition was ultimately attributed to a severe reactive synovitis, not infectious arthritis.
- Repeat MRI two years later showed degenerative changes without signs of infection.
Implications:
- This case expands the understanding of potential severe inflammatory reactions to intra-articular contrast media.
- Clinicians should consider reactive synovitis in the differential diagnosis of joint pain following contrast injection procedures.
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