associated with synovial osteochondromatosis is described. Intraosseus and juxta osseus sclerotic bone lesions were identified on radiographs and computed tomography in a patient with knee pain. The association of osteopoikilosis with synovial osteochondromatosis is rare and to our knowledge has received little attention in the literature. INTRODUCTIONOsteopoikilosis is a hereditary condition. The hallmark of this condition is numerous discrete or confluent round or ovoid calcific or ossific densities often with minimally spiculated margins, in bones, often in proximity to joints (1). These are often incidentally discovered and pathologically represent bone islands. They are occasionally associated with cutaneous lesions as well as other osteosclerotic disorders (2).Synovial osteochondromatosis is a rare benign monoarticular arthropathy. The inciting stimulus which results in the rapid development of this synovial metaplastic process is unknown (3). An embryonic rest has been hypothesised to be the causative factor for the disease (4, 5). Trauma has also been identified as a precipitating factor (4, 6). A neoplastic basis for the cartilaginous metaplasia within the synovial villi is considered by some authors (3, 4, and 5). Although malignant transformation has been reported occasionally (4, 7, and 8) it is controversial as to whether or not chondrosarcomas actually originate in this entity. Synovial chondromatosis most commonly involves the knee, elbow, and hip in young adults (6, 9). The association of osteopoikilosis with synovial osteochondromatosis is rare and to our knowledge has received little attention in the literature.CASE REPORTA 25 year old man presented to the orthopaedics department in our institution with right knee pain and difficulty in walking, progressively increasing for 5 years. He also gave a history of fall, which happened 1 month before the onset of pain. There was no history of tingling or numbness or significant family history. Outside MRI showed tears of both menisci on the right, longitudinal tear of the lateral meniscus and radial tear of the medial meniscus, along with a tear of the lateral collateral ligament of the right knee. The MR also showed nodular lesions in relation to the knee which were hypointense on all sequences, few of which were intra osseous and few were extra osseous. (Figures 1a-c) The patient did not have any other complaints. Examination of the right lower limb revealed wasting of the quadriceps. Rest of the clinical examination was normal. His laboratory values including erythrocyte sedimentation rate, rheumatoid factor, C-reactive protein, uric acid, serum calcium and parathyroid hormone levels were normal.He was referred to the radiology department for a radiograph of the knee joint, which showed mild juxta-articular osteopenia and multiple small discrete, round, oval, dense calcific lesions in a symmetric distribution (Fig. 2 ). These lesions were distributed more in the epiphysis and metaphysis of the femur distally (Fig. 3 ). An AP radiograph of the pelvis did not show any abnormality. All findings were suggestive of osteopoikilosis. There were also few intra articular soft tissue density lesions with peripheral calcifications. A CT scan done thereafter confirmed the findings. (Fig. 4 a and 4c).After the diagnosis, the patient was re-evaluated, and any overlooked pathology was searched. There was no