Weekly Case

Title : Case 566

Age / Sex : 20 / M


Chief complaint : right hip pain (onset: 7 years ago, aggravated 1 month ago)

What is your impression?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy of Geun Young Lee, Chung-Ang University Hospital



Discussion


Answer: Pigmented villonodular synovitis (PVNS), right hip joint


 


Findings: Dark SI intra-articular mass on FS T2WI, with joint effusion. Tiny nodular lesion around ligamentum teres, also.


 


Differential Diagnosis: (1) lipoma aborescens (2) synovial osteochondromatosis (3) siderotic synovitis


 


Discussion: Pigmented villonodular synovitis (PVNS) is a rare synovial disease involving any joint, bursa or tendon sheath, which is divided into two forms- a localised form or nodular tenosynovitis, and diffuse-type (extra-articular) giant-cell tumor. The hip is less frequently affected (15%) than the knee (70%).Clinical manifestation of PVNS is non-specific. Pain is most common symptom. PVNS usually affects a single joint, rather than multiple joints. In general, there is no specific finding on plain radiography or CT, however, osteolytic lesion or erosion may be seen by synovial proliferation. MRI can show the lesion about its location/extent and characteristics, showing intermediate to low signal intensity on T2WI and strong enhancement, with blooming artifact on gradient echo image by hemosiderin deposition.


 


References: Sylvain SteinmetzAnne-Laure Rougemont, Robin Peter. Pigmented villonodular synovitis of the hip. EFORT Open Rev. 2016 Jun; 1(6): 260–266.


 



Correct Answer
Total applicants 30 Correct answers 16
Name Institution
전성희 전문의
김유진 전문의
김미선 전문의
이규정 고대구로병원, 전공의
정소용 생생병원, 전문의
황성태 고대안암병원, 전문의
박준동 뿌리병원, 전문의
여유진 전문의
이혜란 전문의
박선영 한림대학교 성심병원, 전문의
조은경 새움병원, 전문의
권소이 전문의
이은채 전문의
박재일 대구 척탑병원, 전문의
최희석 전병원, 전문의
김동찬 단국대학교 병원, 전공의


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