Learning objectives
To understand the classification of crystal deposition diseases.
To learn the pathophysiology of this disorder.
To understand the clinical manifestations of this disorder.
To learn the radiographic distribution and appearance using example radiographs and the target approach to radiographic diagnosis.
To understand the complications of CPPD crystal deposition disease.
To differentiate CPPD crystal deposition disease from those disorders that can be confused with it,
including hemochromatosis,
osteoarthrosis,
gout and others.
Background
History:
Intra-articular CPPD crystals were initially described by McCarty,
et al in 1961 and 1962.
1,
2
Zitnan and Sitaj had previously described the findings of CPPD crystal-deposition disease in 1958,
calling it “chondrocalcinosis polyarticularis”.
3
Imaging findings OR Procedure Details
Differential Considerations
Osteoarthritis:
Pyrophosphate arthropathy most commonly presents with imaging characteristics similar to OA with a specific distribution.
Subchondral cysts in CPPD CDD are generally larger.
OA in an atypical location (i.e.
radiocarpal joint,
elbow,
patellofemoral joint),
consider CPPD—even in the absence of chondrocalcinosis.
Septic arthritis and gout:
Clinically,
this can be a difficult differentiation from pseudogout attack.
Patients can present with fever and increased erythrocyte sedimentation rate in any of these processes.
Joint aspiration with evaluation for crystals and bacteria is recommended.
Hydroxyapatite crystal...
Conclusion
References:
McCarty DJ,
Hollander JL.
Identification of urate crystals in gouty synovial fluid.
Ann Intern Med 1961; 54:452-460.
McCarty DJ,
Kohn NN,
Faires JS.
The significance of calcium pyrophosphate crystals in the synovial fluid of arthritis patients: the “pseudogout” syndrome.
Ann Intern Med 1962; 56:711-737.
Zitnan D,
Sitaj S.
Chondrocalcinosis articularis.
I.
Clinical and radiological study.
Ann Rheum Dis 1963; 9:397-406.
Steinbach LS,
Resnick D.
Calcium pyrophosphate dihydrate crystal deposition disease revisited.
Radiology 1996; 200:1-9.
Ishikawa K,
Masuda I,
Ohira T,
et al.
A histological...