PMC6667655_01
Soft tissue swelling in the anterio-lateral aspect of the knee.
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Inspection and palpation revealed the swelling of the anterior and anterior-lateral aspect of the knee, which was harder in consistence (Fig. 1).
Proton density fat satturated axial view - high intensity signal lesion in Hoffa's fat pad (arrow); low intensity signal septations (arrowhead).
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Native and post contrast Gadovist (gadobutrol) MRI imaging revealed a large, sharply defined, lobulated lesion of the following sizes: transversal display 54.6 x 30.6 mm (Fig. 2); sagittal display 39.2 x 24.5 mm (Fig. 3); and coronal display 53.7 x 40.6 mm (Fig. 4). The lesion in T1 and T1 fat suppression (with dimensional fat saturation) showed low-signal intensities (Fig. 5, Fig. 6), while in proton density fat suppression sequences (Fig. 2, Fig. 3) and STIR sequences (Short Thau Inversion Recovery) showed high-signal intensity (Fig. 4). Thin lines indicating septations inside the lesion (arrowheads in Figs. 2, 3 and 4) had low-signal intensity in all sequences.
Proton density fat satturated saggital view - high intensity signal lesion in Hoffa's fat pad (arrow); low intensity signal septations (arrowhead).
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Native and post contrast Gadovist (gadobutrol) MRI imaging revealed a large, sharply defined, lobulated lesion of the following sizes: transversal display 54.6 x 30.6 mm (Fig. 2); sagittal display 39.2 x 24.5 mm (Fig. 3); and coronal display 53.7 x 40.6 mm (Fig. 4). Thin lines indicating septations inside the lesion (arrowheads in Figs. 2, 3 and 4) had low-signal intensity in all sequences.
Proton density fat satturated coronal view - high intensity signal lesion in Hoffa's fat pad (arrow); low intensity signal septations (arrowhead).
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Native and post contrast Gadovist (gadobutrol) MRI imaging revealed a large, sharply defined, lobulated lesion of the following sizes: transversal display 54.6 x 30.6 mm (Fig. 2); sagittal display 39.2 x 24.5 mm (Fig. 3); and coronal display 53.7 x 40.6 mm (Fig. 4). The lesion in T1 and T1 fat suppression (with dimensional fat saturation) showed low-signal intensities (Fig. 5, Fig. 6), while in proton density fat suppression sequences (Fig. 2, Fig. 3) and STIR sequences (Short Thau Inversion Recovery) showed high-signal intensity (Fig. 4). Thin lines indicating septations inside the lesion (arrowheads in Figs. 2, 3 and 4) had low-signal intensity in all sequences.
T1 saggital view low intensity signal lesion in Hoffa's fat pad (arrow).
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The lesion in T1 and T1 fat suppression (with dimensional fat saturation) showed low-signal intensities (Fig. 5, Fig. 6), while in proton density fat suppression sequences (Fig. 2, Fig. 3) and STIR sequences (Short Thau Inversion Recovery) showed high-signal intensity (Fig. 4).
T1 fat satturated contrast enhanced axial view showing high intensity signal of the joint capsule and septations (arrows).
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After the intravenous application of the paramagnetic contrast agent, there was a marginal increase in signal intensity of the joint capsule and an irregular linear increase of signal intensity within the corresponding lesion in the septations (Fig. 7, Fig. 8).
Lateral patellar incision and ganglion cyst revealed.
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After the preparation, spinal anaesthesia was administered considering the locality and size of the lesion, which required an open surgical procedure (Fig. 9).
Completely resected ganglion cyst of Hoffa's fat pad.
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The macroscopic appearance of the lesion was characterised by a reddish surface and a clear liquid inside the lesion (Fig. 10).
Pathohistological report confirming ganglion cyst.
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it was a ganglion cyst of Hoffa's fat pad (Fig. 11, Fig. 12).
T1 saggital view showing lov intensity signal in Hoffa's fat pad (arrow); low intensity signal in enlarged proximal segment of patellar ligament (arrowhead).
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Follow-up native and post contrast (gadobutrol-Gadovist) MRI imaging was performed six months after the operation and showed no signs of recidivism or residual ganglion cysts (Fig. 13, Fig. 14, Fig. 15, Fig. 16).
T1 contrast enhanced saggital view showing higher intensity signal in Hoffa's fat pad (arrow-Hoffitis); high intensity signal in enlarged proximal segment of patellar ligament (arrowhead-patellar tendinosis).
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Follow-up native and post contrast (gadobutrol-Gadovist) MRI imaging was performed six months after the operation and showed no signs of recidivism or residual ganglion cysts (Fig. 13, Fig. 14, Fig. 15, Fig. 16).