Fig. 38.

Images of the right knee in a 12-year-old boy with tuberculous tenosynovitis and osteomyelitis. There was a history of a swollen knee for 6 months, no history of trauma and although he was not septic, he was noted to be severely malnourished. a A lateral knee radiograph shows a large joint effusion, suspected synovial thickening and osteopaenia of the patella. No periosteal reaction or focal bone lesion is demonstrated. He proceeded to magnetic resonance imaging (MRI) following a failed attempt at joint aspiration. b A sagittal short tau inversion recovery MRI shows thickened low signal synovium lining the suprapatellar and popliteal fossa with a small amount of fluid in the suprapatellar space. There is also patchy oedema of the patella and femoral epiphysis with cartilage thinning and a focal erosive lesion of the tibial epiphysis. c A sagittal fat saturated T1 post-contrast MRI shows diffuse synovial and patchy multifocal bone enhancement. Synovial biopsy confirmed tuberculosis