Identification of lipohemarthrosis with point-of-care emergency ultrasonography: case report and brief literature review.

BACKGROUND: Traumatic knee pain is a common complaint in the emergency department (ED). Conventional radiographs are often ordered as the initial screening study, but might not be readily available or always identify significant fractures. Ultrasonography has been shown to be useful in the evaluation of knee fractures not identified by radiography.

OBJECTIVES: To discuss and briefly review the literature regarding the use of suprapatellar bursal ultrasonography to detect lipohemarthrosis (LH) as a surrogate marker for an intraarticular knee fracture.

CASE REPORT: A 37-year-old man presented to the ED after a traumatic knee injury. Bedside ultrasonography demonstrated the characteristic triple layer sign of LH, raising the suspicion for an intraarticular fracture. The diagnosis was later confirmed with radiography and computed tomography (CT).

CONCLUSIONS: The sonographic finding of LH may be used as a sensitive surrogate marker for intraarticular knee fracture in the ED. Ultrasound can be considered as an adjunct modality in ED patients with suspicion for fracture and negative knee radiographs.