Case Report

Pigmented Villonodular Synovitis: A Disease in Evolution

HENDA BOUALI, ERIC J. DEPPERT, LAWRENCE J. LEVENTHAL, BRIAN REEVES, and THOMAS POPE

ABSTRACT.

Pigmented villonodular synovitis (PVNS) is a rare, benign, proliferative disease of the synovial membrane of joints, tendon sheaths, and bursas. Joint aspiration typically yields hemorrhagic or xanthochromic/serosanguinous (brown, murky) fluid. We describe a case of PVNS that presented as an acute, painless, nontraumatic right knee effusion with clear synovial fluid on arthrocentesis. Initial magnetic resonance imaging of the knee revealed no evidence for hemosiderin. A diagnostic arthroscopy and surgical arthrotomy revealed a unique case of PVNS evolving from local to diffuse involvement of the synovium. (J Rheumatol 2004;31:1659-62)

Key Indexing Terms:

PIGMENTED VILLONODULAR SYNOVITIS
KNEE JOINT
MAGNETIC RESONANCE IMAGING
SYNOVIAL BIOPSY

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From the Department of Rheumatology, The Graduate Hospital, Philadelphia, Pennsylvania; and the Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.

H. Bouali, MD, Research Fellow, Department of Rheumatology; E.J. Deppert, MD, Co-Director, Internal Medicine Residency Program; L.J. Leventhal, MD, FACP, FACR, Chair, Department of Medicine, Chief, Division of Rheumatology, Program Director, Internal Medicine Residency Program; B. Reeves, DO, Radiology Fellow; T. Pope, MD, FACR, Professor of Radiology, Medical University of South Carolina.

Address reprint requests to Dr. H. Bouali, 1314 Ashley Hall Road, Charleston, SC 29407. E-mail: boualih@musc.edu

Submitted March 31, 2003; revision accepted February 27, 2004.

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