Tuberculous synovitis of the elbow joint

Tuberculous synovitis in the elbow joint is extremely rare in developed cou ntries. We describe a 68-year-old man who had had a gradually enlarging mas s over the volar side of the left proximal forearm near the elbow joint for 4 months Plain roentgenograms of the diseased elbow showed early osteoarth ritic change. Magnetic resonance imaging revealed diffuse synovitis with a large 8x8 cm extra- articular synovial cyst. Synovectomy was performed and histopathologic examination of the surgical specimen revealed granulomatous inflammation with caseation, prominent Langhan's giant cells, and sparse a cid-fast bacilli. The patient had been receiving antituberculous chemothera py for at least 8 months at the time of examination and had no recurrence o f swelling or discharging sinuses during follow-up. Differential diagnoses in patients with elbow swelling should include pigmented villonodular synov itis, hemophilic arthropathy, rheumatoid arthritis, degenerative joint dise ase, and tuberculosis. Simple aspiration may enable earlier diagnosis, befo re destructive arthropathy becomes advanced.