Radiological Case: Pigmented Villonodular Synovitis of the Elbow

C. Frank Gould, MD; Justin Q. Ly, MD; Scot E. Campbell, MD; Douglas P. Beall, MD


Appl Radiol. 2008;37(9):42-43. 

In This Article

Case Summary and Imaging Findings

A 73-year-old woman presented to the authors' institution with increasing elbow pain and swelling. She denied any previous arthritic condition. The physical examination revealed nonspecific diffuse joint tenderness. Conventional radiography of the elbow showed nonspecific swelling around the joint and suggested a small joint effusion (not shown). Further evaluation was obtained with magnetic resonance imaging (MRI).

MRI revealed erosions of the articular surfaces of the radial head and capitellum and decreased subchondral marrow signal that is isointenseto the surrounding muscle (Figure 1). The ulnotrochlear joint shows subchondral cystic change involving the olecranon process (Figure 2). There is fluid surrounding the radial head just distal to the proximal radioulnar joint. There are also areas of decreased signal within the fluid, signifying complex fluid and/or a synovial reaction.

Figure 1.

A coronal T1-weighted MR image of the elbow shows erosions of the articular surfaces of the radial head and capitellum with subtle loss of the cortical margin (black arrowheads). There is also an associated subchondral marrow signal change, with decreased marrow signal that is isointense to the surrounding muscle (white arrows).

Figure 2.

This sagittal T2-weighted MR image through the ulnotrochlear joint shows subchondral cystic change in the olecranon process of the ulna (white arrows) as well as fluid signal anterior to the brachialis tendon (black arrow).


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