Bilateral focal pigmented villonodular synovitis

Case contributed by Dr Mostafa El-Feky

Presentation

Bilateral knee pain, more on the left. No history of trauma.

Patient Data

Age: 45 years
Gender: Female
X-ray

Both knees

Mild osteo-arthritic changes of both knee joints shown as sharpened tibial spines, eburnated medial tibial plateaus and narrowing of patello-femoral joint compartments, with polar patellar osteophytes.

MRI

Right knee

Mild to moderate effusion with synovitis.

An intra-articular synovial based soft tissue mass-like lesion is noted at the lateral recess of the right knee joint cavity, expressing T1 hypo and T2 intermediate to hypointense signal. It is averaging 2.7 x 0.9 x 3.3 cm.

A popliteal cyst is noted in the semimembranosus gastrocnemius bursa.

Moderate effusion with synovitis.

An intra-articular synovial based soft tissue mass-like lesion is noted at the lateral recess of the left knee joint cavity, expressing T1 hypo and T2 intermediate to hypointense signal. It is averaging 2.7 x 0.9 x 3.3 cm.

Suprapatellar plica noticed, with no related cartilaginous erosions identified.

Case Discussion

The MRI study shows bilateral knee soft tissue synovial lesion of low signal intensity on T1 and T2 in keeping with bilateral focal pigmented villonodular synovitis (PVNS). The persistent low signal intensity is likely due to hemosiderin deposition. It is most commonly monoarticular with predilection to the knee joint, rarely to be bilateral. It is commonly associated with joint effusions.

 

Case courtesy; Dr Rim Bastawy, Lecturer of radiodiagnosis, Alexandria University, Egypt.

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Case information

rID: 67643
Published: 12th May 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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