There are only a few reported cases in the literature of pigmented villonodular synovitis (PVNS) involving the elbow. Even more rare is its occurrence in the pediatric population as this condition mainly affects young adults. We report a unique case of an 8 year old girl presenting with diffuse form of PVNS of the elbow. The diagnosis is often not considered by clinical history and plain films as both are nonspecific in suggesting PVNS. MRI demonstrates the characteristic findings of PVNS, and therefore, is the imaging modality of choice for the evaluation of PVNS. When evaluating a pediatric patient with elbow pain, it is important to be aware of PVNS as part of the differential diagnosis if imaging features are suggestive and other etiologies have been excluded by history or imaging.