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Published on: October 20, 2013
Pediatric pigmented villonodular synovitis mimicking a septic hip
Aarat M Patel1, Amanda G Brown, Csaba Galambos
1Division of Rheumatology, School of Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15201, USA. aarat.patel@chp.edu
Summary
Pigmented villonodular synovitis is a rare hip condition often misdiagnosed as infection. Early suspicion and advanced imaging are key for timely diagnosis and appropriate treatment of this challenging disease.
Area of Science:
- Orthopedics
- Pediatric Rheumatology
- Medical Diagnostics
Background:
- Pigmented villonodular synovitis (PVNS) is a rare, benign neoplastic proliferation of the synovium.
- It commonly affects large joints, with the hip being a less frequent but significant site.
- PVNS can present with vague symptoms, mimicking more common conditions like joint infections.
Observation:
- A pediatric case initially misdiagnosed as hip infection is presented.
- Diagnostic delay of 2.5 years occurred due to nonspecific presenting symptoms.
- High index of suspicion is crucial for early identification of PVNS.
Findings:
- Definitive diagnosis typically requires advanced imaging, such as magnetic resonance imaging (MRI), and histopathological confirmation via tissue biopsy.
- Surgical resection is the standard primary treatment for PVNS.
- The described case demonstrated an unusual positive response to conservative management.
Implications:
- This case highlights the diagnostic challenges posed by PVNS in pediatric hip disease.
- Emphasizes the importance of considering rare diagnoses when initial treatments fail.
- Suggests potential for conservative management in select PVNS cases, warranting further investigation.
