Lead "bursogram" and focal synovitis secondary to a retained intraarticular bullet fragment

We present an unusual case in which retained lead bullet in the wrist joint dissolved and migrated into a synovial recess, producing reactive focal synovitis. The clinical presentation suggested a soft tissue mass or ganglion cyst. The radiologic findings of dense metallic fragments within a recess of the wrist joint established the correct diagnosis and excluded other causes of soft tissue masses. Radiologic recognition of retained intra-articular lead fragments is important, as the clinical features of systemic lead intoxication, lead arthopathy, or reactive focal synovitis may be subtle or misleading.