Mindy Yang Licurse, MD

An 11-year-old female presents with persistent chronic swelling of the right greater than left knees and stiffness limiting mobility. Knee radiographs are unremarkable. Representative images from bilateral knee MRI were obtained.

Answer: Pigmented villonodular synovitis (PVNS)


The MRI findings demonstrate diffuse nodular synovial thickening with extensive blooming artifact on gradient echo images and heterogeneous enhancement, in keeping with pigmented villonodular synovitis.  Synovial biopsy results confirmed the diagnosis. Despite recurrent synovectomy attempts, the nodular masses continued to persist and radiation therapy was pursued.


Pigmented villonodular synovitis (PVNS) is a rare disorder of synovial proliferation, which can be seen from adolescents to middle-aged adults. PVNS may present as a localized nodular mass or as a diffuse process, usually in the knee. Key MRI findings include low T1/T2 synovial nodularity with “blooming” artifact seen on gradient-echo images on the basis of hemosiderin contents. Optimal treatment includes marginal excision for localized PVNS or synovectomy for diffuse PVNS. Patients with high risk of recurrence may consider adjuvant radiation therapy, with few expected complications.


Mendenhall WM, Mendenhall CM, Reith JD, Scarborough MT, Gibbs CP, Mendenhall NP.  “Pigmented Villonodular Synovitis.” 

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An 11-year-old female presents with persistent chronic swelling of the right greater than left knees and stiffness limiting mobility. 

Mindy Yang Licurse, MD

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Image IQ: 11-year old Female with Bilateral Knee Swelling