Destructive synovial hemangioma of the hip resembling pigmented villonodular synovitis

We report a case of synovial hemangioma of the hip causing joint destruction severe enough to warrant arthroplasty in a 32-year-old man who presented with a 2-year history of hip pain and worsening limp. Plain radiographs demonstrated advanced degenerative changes of the hip articular surface. Magnetic resonance imaging revealed changes consistent with pigmented villonodular synovitis throughout the joint and erosion of the acetabular bone. A total hip arthroplasty was performed, and histopathologic examination of the resected tissue demonstrated synovial hemangioma. This case, unique in the literature, demonstrates the destructive capacity and diagnostic pitfalls of synovial hemangioma.