Learningradiology calcium, pyrophosphate, deposition. Supported in part by a research grant from the radiology department, chuv. Retroodontoid calcium pyrophosphate dehydrate deposition. Furthermore, conventional radiographs of the upper cervical spine were performed. Cppd commonly involves larger joints, such as the knees, wrists, shoulders, and hips, and has been known to involve the spine. The clinical term pseudogout represents symptomatic acute attacks which present in a similar fashion as.
Expanding upon the core of the highly popular second edition, this updated reference is fully revised to provide the best spinerelated diagnostic support available. Cppd is a type of arthritis that, as the old name of pseudogout suggests, can cause symptoms similar to gout. Imaging anatomy of the human spine a comprehensive atlas including adjacent structures scott e. Pearls and pitfalls accurate diagnosis of acute cervical spine injury requires cooperation between clinician and radiologist, a reliable and repeatable approach to interpreting cervical spine ct, and the awareness that a patient may have a significant and unstable ligamentous injury despite normal findings. Calcification demonstrated as high signal intensity on t1weighted mr images of the disks of the lumbar spine. Cppd crystal deposition disease of the cervical spine. To determine a the prevalence of atlantoaxial calcium pyrophosphate dihydrate cppd crystal deposition in a population of patients undergoing computed tomography ct for acute trauma and b the association between atlantoaxial cppd crystal deposition and retroodontoid softtissue thickness. Crystal arthropathy of the lumbar facet joint is a rare but benign differential diagnosis of spondylodiscitis. Cppd crystal deposition disease of the cervical spine core. Effect of chondrocalcinosis on the mr imaging of knee menisci. Spine, now in its third edition, showcases the latest cuttingedge research from dr. Calcium pyrophosphate dihydrate crystal deposition disease. However, cppd deposition on the cervical spine is less well known, and only a limited number of cases have been reported to date. Here, we report our recent clinical experience with cppd crystal deposition disease of the cervical spine and describe the clinical features of this disease.
The cervical ct scans were analyzed for the presence of periodontoid calci. Radiology of joint disease my practical approach prevalencehx joint anatomy ordered list oa phytes eoa ra gout cppd pa wow 4 of 94 100 conditions affect joints ra. Calcium pyrophosphate dihydrate deposition disease. Both assessors were blinded to the disease status of the patients. In the cervical spine, serious complications have been reported. Lumbar spine chondrocalcinosis the journal of rheumatology. Details of the image cppd of the cervical spine modality. Calcium pyrophosphate deposition cppd disease bpj 55.
Calcium pyrophosphate dihydrate cppd deposition in the cervical spine is an unusual cause of cervical spinal cord compression and myelopathy. She had inflammatory low back pain for a month with lowgrade fever and creactive protein crp up to 3 mgdl. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Cppd crowned dens syndrome with clivus destruction. A similar retrospective analysis of 5 cervical spine ct scans in an adult.
We report a 54yearold male presenting with progressive neck pain and numbness of the extremities. Melorheostosis involving the cervical and upper thoracic. An awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. Few anatomic reports in the literature illustrate the multitude of pathologic conditions affecting the intervertebral disk and the anatomic structures in the diskovertebral segment 3, 1719. Chondrocalcinosis, which is calcification of the articular cartilage, most often caused by cppd, is estimated to affect 5% of the general population, and prevalence increases with age. In 12 cases there were calcifications of the syndesmoodontoid region. Melorheostosis, an uncommon mesenchymal dysplasia, rarely affects the axial skeleton. Cppd is known to affect the elderly population and commonly manifests as inflammation of knees, hips, and shoulders. Calcium pyrophosphate dihydrate cppd crystal depo sition disease, or. The deposition of calcium pyrophosphate dihydrate cppd crystals in. Borden, md neuroradiologist associate professor of radiology the university of vermont medical center.
Lspine what films to order ap and lateralon all patients coned down view of l5s1 mostly unnecessary with digital radiology flexex views looking for instability will give info on loss of motion and spasm oblique views looking for foraminal stenosis and spondylolysis pars defect. Finckh is supported by a scholarship from the swiss national science foundation, and partially by nih grant p60 ar 47782. Calcium pyrophosphate deposition disease radiology. Cppd deposition disease, also known as pseudogout, is rare, but may also lead to spinal. Musculoskeletal radiology cppd crowned dens syndrome. There is little research into the prevalence of symptomatic calcium pyrophosphate deposition cppd disease. Cppd in the spine include calcium deposition within the supraspinous and interspinous ligaments, anterior and posterior longitudinal ligaments, intervertebral discs, and joint capsule. Procedure codes associated with musculoskeletal imaging. Cpp deposits in the spine were diagnosed by conventional radiography andor ctscan. Twentyseven patients with definite or probable cppd have been investigated with systematic frontal and lateral tomograms of the cervicooccipital region. Cppd crystal deposition in the cervical spine is seen with a higher. Arthros joint it is inflammation when joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. Calcium pyrophosphate dihydrate crystal depositiontriad.
Calcium pyrophosphate dihydrate cppd crystal deposition disease is characterized by the accumulation of cppd crystal in articular and periarticular tissues, but cppd crystal deposition along the spinal dura mater has not been previously reported. There is also chondrocalcinosis of the triangular fibrocartilage of the distal ulna. Objectives to agree terminology and to develop recommendations for the diagnosis of calcium pyrophosphate deposition cppd. European league against rheumatism recommendations for. Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate dihydrate deposition disease cppd pseudogout. Chondrocalcinosis results with deposition of cppd crystals in cartilage. Calcium pyrophosphate dihydrate cppd disease or pseudogout of the cervical spine a partially calcified mass is seen behind the odontoid process compressing the cervical cord, socalled periodontoid pseudotumor it is an often misrecognized cause of acute neck pain in the elderly. Cervical spine trauma page 2 of 10 many now advocate ct for all trauma cases in which the cspine needs to be evaluated. Calcium pyrophosphate dihydrate cppd crystal deposition disease is slightly more prevalent in men. Calcium pyrophosphate deposition disease cppd is both a hereditary and a sporadic condition that results in calcification of hyaline and fibrocartilage, joint capsules, synovial tissue. Trauma induced calcium pyrophosphate deposition disease of. Spinal involvement with calcium pyrophosphate deposition. Clinical, radiographic and pathologic abnormalities in.
Cppd disease involving the spine has been infrequently encountered in practice and rarely described in the literature. Ecr 2014 c0602 conventional radiography cr, computed. We describe the imaging findings of melorheostosis involving the cervical and upper thoracic spine. American society of spine radiology, and american society of neuroradiology proposed a new nomenclature and consistent classification system, intended for the reporting of imaging studies. Calcium pyrophosphate dihydrate disease cppd, also known as pyrophosphate arthropathy or pseudogout, is defined by the cooccurrence of arthritis with evidence of cppd deposition within the articular cartilage. Radiographs and ct showed unilateral wellmarginated undulating zones of cortical hyperostosis involving multiple vertebrae that were contiguous with a coalescent ossified right. Frequency of atlantoaxial calcium pyrophosphate dihydrate. Cppd of hand and wrist upper photo shows hooklike projections arising from radial aspect of metacarpal heads. Oftentimes an incidental finding in elderly patients, it can occasionally be associated with fever, neck pain and. Patients with and without spinal cppd were compared by fishers exact test for categorical data and wilcoxon test for quantitative data. Imaging of common orthopaedic pain disclosures i have nothing to disclose. However, computed tomography ct imaging of the cervical spine demonstrated linear calcific deposits in the transverse ligament of atlas in all patients. Specific case of crystal deposition disease in the spine. Pseudogout of the cervical and thoracic spine mimicking.
Effect of chondrocalcinosis on the mr imaging of knee. Methods the european league against rheumatism eular cppd task force, comprising 15 experts from 10 countries, agreed the terms and recommendations for diagnosis of cppd using a delphi consensus approach. Welcome to the radiology assistant educational site of the radiological society of the netherlands by robin smithuis md. Calcifications involving the transverse ligament around the odontoid process can be seen in crowned dens syndrome, typically associated with cppd crystal deposition.
We report a case of compressive cervical myelopathy due to cppd deposition disease of the cervical spine in a woman with longstanding rheumatoid arthritis. Imaging of calcium pyrophosphate deposition disease ncbi. Yet, in cppd, a different type of crystal, called calcium pyrophosphate, triggers the reaction. Pseudogout is a form of acute calcium pyrophosphate deposition cppd disease that typically afflicts the elderly. Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate dihydrate deposition disease cppd pseudogout are outlined in an investigation of 85 patients with definite or probable disease and available cadaveric and human surgical material. Forseen, md assistant professor, neuroradiology section department of radiology and imaging georgia regents university augusta, georgia neil m. A 70yearold woman with a recent sigmoid diverticulitis was examined for a suspicion of infectious spondylodiscitis. The present study is unique not only in terms of the large number of cadavers and disk levels involved but also in its utilization of radiographic examination of sections of the specimen rather than the. Pdf calcium pyrophosphate dihydrate cppd crystal deposition disease is. Radiological identification and analysis of soft tissue.
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