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Pigmented villonodular synovitis

Case contributed by Ahmed Abdrabou
Diagnosis almost certain


Knee joint pain, swelling and limitation of movement over the last 3 months

Patient Data

Age: 60 years
Gender: Male

An osteolytic lesion is noted at the medial femoral condyle associated with large amount of knee joint effusion. The joint space is preserved. 

Diffuse synovial thickening that forms intra articular masses, the largest one is irregular in shape, is noted anterior to the medial femoral condyle and displaying low signal on T2 and T2* sequences. Large amount of knee joint effusion. Synovial enhancement following contrast administration is seen. 

Case Discussion

The characteristic low T2 signal intensity of the nodular synovial thickening and masses is suggestive of pigmented villonodular synovitis (PVNS) due to hemosiderin deposition from repeated hemorrhage. A biopsy was taken from the sizable mass anterior to the medial femoral condyle and confirmed the diagnosis. 

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