There are only a handful of reported cases in the literature of pigmented villonodular synovitis (PVNS) involving the elbow. Even more rare is its occurrence in the pediatric population as this condition mainly affects young adults. We report a unique case of an 8 year old girl presenting with diffuse form of PVNS of the elbow. While the diagnosis could be considered on radiography, the characteristic findings of PVNS are nicely demonstrated on MRI. When evaluating a pediatric patient with elbow pain, it is important to consider PVNS as part of the differential diagnosis.