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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.
Abstract:
A 57-year-old patient developed severe, persistent pain following MR arthrography with iodinated contrast. MRI 1 week later showed synovitis which was new compared to the prior MRI. Arthroscopy showed severe synovitis. Histopathology showed synovitis characterized by lymphocytes, neutrophils, and necrosis. One out of 4 intraoperative cultures was positive, but ultimately believed to be due to contaminants. CRP normalized within 1 month. Repeat MRI 2 years later showed progressive degenerative findings, but no evidence of ongoing infection, or stigmata of previous infection. We believe this to be an unusually severe case of reactive synovitis. The purpose of the report is to add to knowledge of reactions to intra-articular contrast injection.
Insights
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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