PB0480 - Periarticular Hemangioma as a Cause of Chronic Arthropathy due to Hemarthrosis

Background: Hemangioma is a benign vascular tumor that is commonly seen in pediatric age group. It is often localized at head/neck region. The rare localizations such as periarticular regions can result in misdiagnosis.

Aims: In this abstract, we aimed to present a patient with complaint of ankle pain and swelling for three years and has been diagnosed with periarticular hemangioma after further evaluations.

Methods: Patient was followed up by pediatric rheumatology and orthopedic outpatient clinics with complaint of right ankle pain and swelling for three years. He was diagnosed as juvenile idiopathic arthritis and received oral methotrexate. When the undulant complaints persisted on, the magnetic resonance imaging was run. The MRI scan revealed periarticular hemangioma and patient was referred to pediatric hematology and oncology clinic.

Results: There was swelling and decreased range of motion on right ankle and atrophy of calf muscle on first admission to our clinic. Other physical examinations were done and were within normal limit. Past medical history and family history was not specific. The laboratory results containing coagulation parameters were within normal limit. The MRI scan of right ankle showed hemarthrosis and one cm diameter nodular lesion at periarticular region. The radiology report and another center’s biopsy pathology report indicated hemangioma. Patient was evaluated for hemarthrosis and clinical and laboratory data guided us to hemangioma and was started oral propranolol. After three months, her complaints were regressed.

Conclusion(s): Periarticular hemangioma can cause to intra-articular hemorrhage, hemarthrosis and by chronically mechanical irritation to arthropathy. The differential diagnosis can include hemophilia and rheumatologic disease. The MRI scan has priority for diagnosis. Pathological diagnosis might be invasive for childhood age group. The treatment is oral propranolol and/or arthroscopic surgical resection. Children with chronic arthropathy can be evaluated by periarticular hemangioma. Differential diagnosis such as hemophilic arthropathy should be taken into consideration.