1978, British Journal of Radiology, 51, 916-917 Case reports 9
Laboratory data: Hgb 13.5 g/dl, WBC 11.6x10 /l with a normal differential count, platelets 295 X 109/l, alkaline phosphatase 1203—252 u/1 (50-275 u/1) aspartate aminotransferase 82—15 u/1 (10-40 u/1). Urine: protein 0.4 g/1. Sediment: five red cells per h p f. Cultures from tonsils and pharynx were negative as were several blood cultures. Examination for tubercle bacilli by microscopy and culture was negative. DISCUSSION
DEMASI, C. J., 1967. Allergic pulmonary infiltrates probably due to nitrofurantoin. Archives of Internal Medicine, 120, 631-634. EASTMOND, C. J., 1976. Diffuse alveolitis as complication of penicillamine treatment for rheumatoid arthritis. British Medical Journal, 1, 1506. EVERTS, C. S., WESTCOTT, J. L., and BRAGG, D. G , 1973.
Methotrextae therapy and pulmonary disease. Radiology, 107, 539-543. MCCORMICK, J. N., WOOD, P., and BELL, D., 1976. Peni-
Miliary pulmonary infiltrates have not previously been reported as a complication of treatment with penicillamine. In our patient penicillamine had been administered for seven weeks before the onset of pulmonary changes which disappeared within two weeks after the drug had been withdrawn. It is unlikely that the lung changes were caused by other drugs given to the patient at the same time, by infection or by the rheumatoid arthritis. REFERENCES Clinical Screening Co-operative Group of the EORTC, 1970. Study of the clinical efficiency of bleomycin in human cancer. British Medical Journal, 2, 643-645.
cillamine-induced Goodpasture's syndrome. In Penicillamine Research in Rheumatoid Disease. Ed. E. Munthe. Proceedings from "Penicillamine in Rheumatic Diseases", Symposium, Norway, March 7th-10th, pp. 268-275. STERNLIEB, I., BENNETT, B., and SCHEINBERG, I. H., 1975.
D-penicillamine induced Goodpasture's syndrome in Wilson's disease. Annals of Internal Medicine, 82, 673-675. STRAUSS, W. G. and GRIFFIN, L. M., 1967. Nitrofurantoin
pneumonia. The Journal of the American Medical Association, 199, 175-176. WILSON, E. S. and MCCARTY, R. J., 1968. Nitrofurantoin
pneumonia. The American Journal of Roentgenology, 103, 540-542. WINTERBAUER, R. H., WILSKE, K. R., and WHEELIS, R. F.,
1976. Diffuse pulmonary injury associated with gold treatment. The New England Journal of Medicine, 294, 919-921.
Bilateral pigmented villonodular synovitis of the hip By R. L Eisenberg, M.D., and M. W . Hedgcock, M.D. Departments of Radiology, University of California School of Medicine, and Veterans Administration Hospital, San Francisco, California 94143, U.S.A. {Received December, 1977 and in revised form April, 1978) Pigmented villonodular synovitis (PVS) involving the hip joint is unusual; polyarticular involvement is still more unusual. We wish to present a case of bilateral hip joint involvement by PVS.
DISCUSSION
Jaffe (1958) stated that pigmented villonodular synovitis involves the knee approximately 10-15 times as frequently as the hip. Only five cases of polyarticular pigmented villonodular synovitis have been reported (Byers et al., 1968; Gehweiler and CASE REPORT A 42-year-old male was evaluated for progressive right Wilson, 1969; Greenfield and Wallace, 1950; hip pain and joint swelling over a ten-month period. Radio- Leszcynski et al., 1975). Bilateral involvement of the graphs revealed marked cystic abnormalities bilaterally involving the acetabulum and the femoral head and neck, both hip by this disease has not previously been reported. in the immediate subchondral region and at a distance from As in most of the previously reported patients the joint surface (Fig. 1). The patient also mentioned mild left hip pain, though of far less severity than on the right. having pigmented villonodular synovitis, gradually Synovectomy of the right hip was performed; the synovial increasing pain and swelling were the presenting tissue was diffusely thickened with brown nodular prolifer- symptoms in our patient. The large cystic areas ations. Pathological examination of the synovium demonstrated numerous villi with haemosiderin-laden polyhedral noted both in the immediate subchondral region and cells in a mass of connective tissue; the connective tissue was at a distance from the hip joint surface are findings myxoid in some areas and hyaline in others—all these find- similar to those previously reported (Breimer and ings were consistent with pigmented villonodular synovitis. The postsurgical course was uneventful and the patient Freiberger, 1958; Case Records of the Massachusetts soon became fully ambulatory. Two years later he began to General Hospital, 1944, 1951; Chung and Janes, complain of increasing left hip pain and swelling. Radiographs revealed no change in the bilateral cystic abnormal- 1965; Gehweiler and Wilson, 1969; Ghormley and ities. A synovectomy of the left hip was performed and the Romness 1954; Jaffe, 1958; McMaster, 1960; Smith pathological findings were the same as those for the pre- and Pugh, 1962). It should be emphasized that such viously operated side. Again, the postsurgical course was cystic abnormalities occur more in the hip than in uneventful and the patient became fully ambulatory. 916
NOVEMBER 1978
Case reports
FIG. 1. Radiograph demonstrates marked cystic abnormalitiesbilaterally involving the acetabulum and the femoral head and neck.
CASE 37292,1951. New England Journal of Medicine, 245, 112-115.
any other joint (Breimer and Freiberger, 1958). No significant sclerosis of the femoral head was seen in our patient, although this has occasionally been present (Chung and James, 1965; Smith and Pugh, 1962). Although pigmented villonodular synovitis is usually monoarticular, it should be considered in the differential diagnosis of polyarticular joint disease manifested by joint swelling and cystic abnormalities.
CHUNG, S. M. K., and JANES, J. M., 1965. Diffuse pig-
mented villonodular synovitis of the hip joint: review of the literature and report of four cases. Journal of Bone and Joint Surgery, 47-A, 293-303. GEHWEILER, J. A., and WILSON, J. W., 1969. Diffuse bi-
articular pigmented villonodular synovitis. Radiology, 93, 845-851. GHORMLEY, R. K., and ROMNESS, J. O., 1954. Pigmented
villonodular synovitis (xanthomatosis) of the hip joint. Mayo Clinic Proceedings, 29, 171 -180. GREENFIELD, M. M., and WALLACE, K. M., 1950. Pigmented
REFERENCES BREIMER, C. W., and FREIBERGER, R. H., 1958. Bone lesions
associated with villonodular synovitis. American Journal ofRoentgenology, 79, 618-629.
villonodular synovitis. Radiology, 54, 350-356. JAFFE, H. L., 1958. Tumors and Tumorous Conditions of the Bones and Joints. Philadelphia, Lea and Febiger., P. 534. LESZCYNSKI, J., HUCKELL, J. R., PERCY, J. S., LERICHE, J.
1968. The diagnosis and treatment of pigmented villonodular synovitis. Journal of Bone and Joint Surgery, 50-B, 290-305.
C , and LENTLE, B. C., 1975. Pigmented villonodular synovitis of multiple joints: occurrence in a child with cavernous haemangioma of lip and pulmonary stenosis. Annals of the Rheumatic Diseases, 34, 369-272. MCMASTER, P. E., 1960. Pigmented villonodular synovitis with invasion of bone: report of six cases. Journal of Bone and Joint Surgery, 42-A, 1170-1183.
CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL:
SMITH, J. H., and PUGH, D. G., 1962. Roentgenographic
BYERS, P. D., COTTON, R. E., DEACON, O. W., LOWY, M., NEWMAN, P. H., SISSONS, H. A., and THOMPSON, A. D.,
CASE 30131, 1944. New England Journal of Medicine, 230, 409-412.
917
aspects of articular pigmented villonodular synovitis. American Journal of Roentgenology, 87, 1146-1156.
Laboratory data: Hgb 13.5 g/dl, WBC 11.6x10 /l with a normal differential count, platelets 295 X 109/l, alkaline phosphatase 1203—252 u/1 (50-275 u/1) aspartate aminotransferase 82—15 u/1 (10-40 u/1). Urine: protein 0.4 g/1. Sediment: five red cells per h p f. Cultures from tonsils and pharynx were negative as were several blood cultures. Examination for tubercle bacilli by microscopy and culture was negative. DISCUSSION
DEMASI, C. J., 1967. Allergic pulmonary infiltrates probably due to nitrofurantoin. Archives of Internal Medicine, 120, 631-634. EASTMOND, C. J., 1976. Diffuse alveolitis as complication of penicillamine treatment for rheumatoid arthritis. British Medical Journal, 1, 1506. EVERTS, C. S., WESTCOTT, J. L., and BRAGG, D. G , 1973.
Methotrextae therapy and pulmonary disease. Radiology, 107, 539-543. MCCORMICK, J. N., WOOD, P., and BELL, D., 1976. Peni-
Miliary pulmonary infiltrates have not previously been reported as a complication of treatment with penicillamine. In our patient penicillamine had been administered for seven weeks before the onset of pulmonary changes which disappeared within two weeks after the drug had been withdrawn. It is unlikely that the lung changes were caused by other drugs given to the patient at the same time, by infection or by the rheumatoid arthritis. REFERENCES Clinical Screening Co-operative Group of the EORTC, 1970. Study of the clinical efficiency of bleomycin in human cancer. British Medical Journal, 2, 643-645.
cillamine-induced Goodpasture's syndrome. In Penicillamine Research in Rheumatoid Disease. Ed. E. Munthe. Proceedings from "Penicillamine in Rheumatic Diseases", Symposium, Norway, March 7th-10th, pp. 268-275. STERNLIEB, I., BENNETT, B., and SCHEINBERG, I. H., 1975.
D-penicillamine induced Goodpasture's syndrome in Wilson's disease. Annals of Internal Medicine, 82, 673-675. STRAUSS, W. G. and GRIFFIN, L. M., 1967. Nitrofurantoin
pneumonia. The Journal of the American Medical Association, 199, 175-176. WILSON, E. S. and MCCARTY, R. J., 1968. Nitrofurantoin
pneumonia. The American Journal of Roentgenology, 103, 540-542. WINTERBAUER, R. H., WILSKE, K. R., and WHEELIS, R. F.,
1976. Diffuse pulmonary injury associated with gold treatment. The New England Journal of Medicine, 294, 919-921.
Bilateral pigmented villonodular synovitis of the hip By R. L Eisenberg, M.D., and M. W . Hedgcock, M.D. Departments of Radiology, University of California School of Medicine, and Veterans Administration Hospital, San Francisco, California 94143, U.S.A. {Received December, 1977 and in revised form April, 1978) Pigmented villonodular synovitis (PVS) involving the hip joint is unusual; polyarticular involvement is still more unusual. We wish to present a case of bilateral hip joint involvement by PVS.
DISCUSSION
Jaffe (1958) stated that pigmented villonodular synovitis involves the knee approximately 10-15 times as frequently as the hip. Only five cases of polyarticular pigmented villonodular synovitis have been reported (Byers et al., 1968; Gehweiler and CASE REPORT A 42-year-old male was evaluated for progressive right Wilson, 1969; Greenfield and Wallace, 1950; hip pain and joint swelling over a ten-month period. Radio- Leszcynski et al., 1975). Bilateral involvement of the graphs revealed marked cystic abnormalities bilaterally involving the acetabulum and the femoral head and neck, both hip by this disease has not previously been reported. in the immediate subchondral region and at a distance from As in most of the previously reported patients the joint surface (Fig. 1). The patient also mentioned mild left hip pain, though of far less severity than on the right. having pigmented villonodular synovitis, gradually Synovectomy of the right hip was performed; the synovial increasing pain and swelling were the presenting tissue was diffusely thickened with brown nodular prolifer- symptoms in our patient. The large cystic areas ations. Pathological examination of the synovium demonstrated numerous villi with haemosiderin-laden polyhedral noted both in the immediate subchondral region and cells in a mass of connective tissue; the connective tissue was at a distance from the hip joint surface are findings myxoid in some areas and hyaline in others—all these find- similar to those previously reported (Breimer and ings were consistent with pigmented villonodular synovitis. The postsurgical course was uneventful and the patient Freiberger, 1958; Case Records of the Massachusetts soon became fully ambulatory. Two years later he began to General Hospital, 1944, 1951; Chung and Janes, complain of increasing left hip pain and swelling. Radiographs revealed no change in the bilateral cystic abnormal- 1965; Gehweiler and Wilson, 1969; Ghormley and ities. A synovectomy of the left hip was performed and the Romness 1954; Jaffe, 1958; McMaster, 1960; Smith pathological findings were the same as those for the pre- and Pugh, 1962). It should be emphasized that such viously operated side. Again, the postsurgical course was cystic abnormalities occur more in the hip than in uneventful and the patient became fully ambulatory. 916
NOVEMBER 1978
Case reports
FIG. 1. Radiograph demonstrates marked cystic abnormalitiesbilaterally involving the acetabulum and the femoral head and neck.
CASE 37292,1951. New England Journal of Medicine, 245, 112-115.
any other joint (Breimer and Freiberger, 1958). No significant sclerosis of the femoral head was seen in our patient, although this has occasionally been present (Chung and James, 1965; Smith and Pugh, 1962). Although pigmented villonodular synovitis is usually monoarticular, it should be considered in the differential diagnosis of polyarticular joint disease manifested by joint swelling and cystic abnormalities.
CHUNG, S. M. K., and JANES, J. M., 1965. Diffuse pig-
mented villonodular synovitis of the hip joint: review of the literature and report of four cases. Journal of Bone and Joint Surgery, 47-A, 293-303. GEHWEILER, J. A., and WILSON, J. W., 1969. Diffuse bi-
articular pigmented villonodular synovitis. Radiology, 93, 845-851. GHORMLEY, R. K., and ROMNESS, J. O., 1954. Pigmented
villonodular synovitis (xanthomatosis) of the hip joint. Mayo Clinic Proceedings, 29, 171 -180. GREENFIELD, M. M., and WALLACE, K. M., 1950. Pigmented
REFERENCES BREIMER, C. W., and FREIBERGER, R. H., 1958. Bone lesions
associated with villonodular synovitis. American Journal ofRoentgenology, 79, 618-629.
villonodular synovitis. Radiology, 54, 350-356. JAFFE, H. L., 1958. Tumors and Tumorous Conditions of the Bones and Joints. Philadelphia, Lea and Febiger., P. 534. LESZCYNSKI, J., HUCKELL, J. R., PERCY, J. S., LERICHE, J.
1968. The diagnosis and treatment of pigmented villonodular synovitis. Journal of Bone and Joint Surgery, 50-B, 290-305.
C , and LENTLE, B. C., 1975. Pigmented villonodular synovitis of multiple joints: occurrence in a child with cavernous haemangioma of lip and pulmonary stenosis. Annals of the Rheumatic Diseases, 34, 369-272. MCMASTER, P. E., 1960. Pigmented villonodular synovitis with invasion of bone: report of six cases. Journal of Bone and Joint Surgery, 42-A, 1170-1183.
CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL:
SMITH, J. H., and PUGH, D. G., 1962. Roentgenographic
BYERS, P. D., COTTON, R. E., DEACON, O. W., LOWY, M., NEWMAN, P. H., SISSONS, H. A., and THOMPSON, A. D.,
CASE 30131, 1944. New England Journal of Medicine, 230, 409-412.
917
aspects of articular pigmented villonodular synovitis. American Journal of Roentgenology, 87, 1146-1156.
