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Pigmented villonodular synovitis — SCE Rheumatology MCQ

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HardMusculoskeletal investigationsPigmented villonodular synovitisSCE Rheumatology

A 62-year-old man has chronic destructive knee swelling. MRI shows blooming low-signal synovial proliferation and erosions; aspiration is blood-stained and cultures are negative. He has no coagulopathy. What is the most likely diagnosis?

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Correct answer: D — Pigmented villonodular synovitis

PVNS causes proliferative haemosiderin-laden synovitis with blooming on MRI and recurrent blood-stained effusions. RA and gout can erode joints but do not classically produce this MRI haemosiderin pattern. Orthopaedic and specialist synovial assessment is usually required.

Reference: BSR rheumatology curriculum