Spontaneous Recurrent Hemarthrosis of the Knee Joint: Endovascular Treatment of a Ruptured Aneurysm with Platinum Microcoils. A Case Report*

Arterial aneurysms are a rare cause of hemarthrosis and, in the reports in which such a lesion did lead to hemarthrosis, the aneurysm was postoperative (a pseudoaneurysm)9. These pseudoaneurysms have usually been repaired operatively, although we found two reports, involving three patients, in which therapeutic embolization was performed7,10. We present a case in which massive recurrent hemarthrosis of the left knee joint occurred spontaneously because of a ruptured true aneurysm of the descending genicular artery. This artery was occluded by means of endovascular placement of platinum microcoils. A fifty-one-year-old man was seen because of recurrent swelling of the left knee. He reported pain and tenderness and had a decreased range of motion of that knee. The patient had a three-month history of spontaneously recurring hemorrhagic effusions in the knee, which had been treated with aspiration on three occasions. Blood cultures had been negative. Arthroscopy had been performed one month before the patient was admitted to our hospital, but no source of bleeding was found. Radiographs of the left knee revealed signs of osteoarthrosis (degenerative joint disease) and chondrocalcinosis of the menisci. Magnetic resonance imaging of the left knee demonstrated hemorrhagic joint effusion and thickening of the synovial tissue in the suprapatellar pouch, suggesting proliferative synovial tissue disease. A second arthroscopic procedure, with therapeutic partial synovectomy, was performed. There were massive blood clots in the …