We present a 16 year old student with right elbow pigmentary villonodular synovitis. Clinical diagnosis, radiological features, MRI findings, biopsy results, management and follow up are discussed. MRI is the diagnostic modality of choice and assists the surgeon for a proper incision. Correlation of all the clinical aspects and the histologic features is usually required for definitive diagnosis. A complete surgical synovectomy provides the best chance for cure, but the goal of eradication of this benign process must be balanced against the morbidity of more aggressive surgery. The patient made a full recovery at the end of 4 years and leads a normal life. Pigmented villonodular synovitis should be included in the differential diagnosis of elbow monoarticular joint swelling in young and middle-aged adults.