PVNS MRI: False Recurrence at 6 months

(Correction 02/13/2013): 6 mo f/u MRI 06/2012 showed a false pvns recurrence. It was proven during f/u surgery on 12/14/2012 that the mri was showing scar tissue and not pvns. After you have surgery the mris become more difficult to read accurately. After the 6 mo f/u mri I had two more mris done showing that the (false) pvns was remaining stable (unchanged) that was the clue that it was scar tissue and not pvns.

I picked up the 6 month f/u report on the pvns knee as I was waiting to have an mri done on my per se good knee. My heart plummeted and my energy drained as I read that the pvns is back and also now in the tendons. “No!” flowed out as I exhaled. Realizing I was surrounded by strangers... I became quiet again. I kept reading the report over and over as if reading it again would miraculously change the words. 

If I actually believed in God I’d be saying “what the fuck” and blaming him. The truth is no one is to blame except for this bastard of a disease that insists on having a presence in my life. I’m just wondering “now what?” 

I already had an open synovectomy for diffuse pvns of the left knee in December 2011. Endured the severe fatigue and expense $26k of 18 radiation treatments at 200 greys each, causing adhesions to form. Then 4 1/2 months post op going back into to surgery to have manipulation under anesthesia done on my knee in order to regain movement. Along with all of this 4 1/2 months of PT. After all of this treatment my knee feels destroyed and knee pain now wakes me up at night along with the back pain. 

I was hoping for the best but my gut feeling kept telling me that my knee was not healing properly. It remained way too hot, swollen, stiff and painful for everything to be ok in it. I was hoping to be one of the lucky ones who are able to put pvns on a back burner and continue forward with life but obviously 20% recurrance wasn’t good enough odds for me.

I feel like I'm in a boxing ring and every time I get back on my feet another fist is smacking me in the face. I know that others deal with much worse situations but today I’m going to throw a pity party, pamper myself and rest before the next round.

SIX MONTH FOLLOW UP MRI

Referring Physician: Amalia M De Comas MD

SimonMed Palm Valley II DIAGNOSTIC IMAGING REPORT

Age:47 Diag. Imaging #990526

Patient: Jeffrey, Carol Status: Outpatient

Exam # 3245538 - Jun 18.'2012 - MRI - LOWER EXTREMITY JT W/O CON - Left

CLINICAL DATA: Left knee pain and swelling, history of synovectomy and history of tumor with radiation treatment in the knee.

COMPARISON: MRI Left Knee I ll7l20ll MRI TECHNIQUE: Multiplanar, multisequence imaging was performed without contrast. IMPRESSION:

1. New, diffuse thickening and intratendinous signal involves the extensor mechanism quadriceps and patellar tendons where AP dimension distal quadriceps measures 2 cm and mid fibers patellar tendon 1.4 cm. This may relate to rare intratendinous extension of pigmented villonodular synovitis, postsurgical or less likely, post irradiation changes, correlate clinically.

2. Joint effusion and synovitis again noted. Hypointense posterolateral signal abutting the tibia is not significantly changed. Mixed signal intensity along the posterior capsule appears stable with additional, 12 mm hypointense focus superior margin of the capsule which is new compared to previous study. Overall decreased size of popliteal cys! however, multiple foci of hypointensity present diffusely within popliteal cyst most prominent at the inferior margin. Suprapatellar soft tissues and region of previous hypointensity not entirely included on current examination. Findings most likely relate to residual focus of pigmented villonodular synovitis and/or recurrent disease.

3. Lateral meniscus degenerative horizontal cleavage tear body extending into the anterior horn is unchanged. No acute injury. Laterulmeniscus appears intact.

4. No acute ligament disruption. Stable mild tricompartmental degenerative changes where osteophytes and chondral thinning noted. No acute fracture. Additional soft tissue support structures grossly maintained.

dd: Jun 19,2012

Reported by: Janet Martin M.D. Electronically signed by: Janet Martin M.D

I am not a physician and the above is in no way to be taken as medical advise. This is my interpretation of what I have been told by my physicians and from what I have read. Always consult with a professional to determine your individual risk factors.