PMC4896166_01
Figure 1. 8-year-old girl with PVNS. Lateral (a) and AP (b) elbow radiographs demonstrate large elbow joint effusion with preserved joint spaces.
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Initial radiographs (Fig. 1) of the elbow demonstrated a large elbow joint effusion displacing the anterior and posterior fat pads.
Figure 2: 8-year-old girl with PVNS. A, T1 Sagittal MRI (TR 700, TE 9; B, Proton Density Sagittal MRI (TR 3000, TE 32); C, Gradient Echo Sagittal MRI (TR 750, TE 17, FA 30); D, Axial T1 MRI (TR 700, TE 9); E, Coronal T1 MRI (TR 700, TE9); demonstrate nodular low signal intensity mass on all sequences in the anterior and posterior elbow joint spaces consistent with hemosiderin deposits characteristically seen with PVNS.
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MRI demonstrated a large area of synovial nodular soft tissue masses within anterior and posterior joint space low signal on T1-weighted and proton density pulse sequences (Fig. 2), which represented hemosiderin deposits. Gradient echo pulse sequence demonstrated more pronounced low signal due to increased susceptibility artifact from hemosiderin (Fig. 2C).
8-year-old girl with PVNS. Images from arthroscopic synovectomy. Labels: A = Reddish-brown synovial fronds; B = 3.5mm mechanical shaver; C = Non-pigmented synovial hypertrophy; D = Proximal portion of the capitellum; E = Uninvolved joint capsule/synovium laterally; F = Medial joint capsule/synovium.
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The patient subsequently underwent successful four portal elbow arthroscopy, and a complete arthroscopic synovectomy was performed (Fig. 3).
8-year-old girl with PVNS. Photomicrograph of synovial tissue (H & E stain 400x magnification). Arrows point to two multinucleated giant cells containing brown pigmentation within the cytoplasm secondary to hemosiderin.
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H & E stain of synovial sample (Fig. 4) demonstrated hemosiderin laden within cytoplasm of multiple multinucleated macrophages characteristic of pigmented villonodular synovitis.