The X-Files: June 2008

Marshall Deltoff
June 18, 2008
Written by Marshall Deltoff
xfilesa
Figure A
xfilesb
Figure B





























Thank you so much to Dr. Rosanne Metz of Toronto for this case.  This 46-year-old man presented with chronic mild dull aching, crepitus and reduced range of motion of his left elbow.  Radiographs revealed an intra-articular collection of amorphous, somewhat flocculent calcific densities in a region of soft tissue swelling immediately medial and posterior to the proximal ulna (Figures A and B).

DIAGNOSIS:
Synoviochondrometaplasia

DISCUSSION:
  • a benign arthropathy characterized by formation of intra-articular loose bodies
  • synonyms include osteochondromatosis, osteochondral loose bodies, joint mice
  • synovial metaplasia forms cartilage which detaches and may calcify or ossify, resulting in multiple intra-articular loose bodies
  • clinically most prevalent in males (3:1) between 30-50 years of age
  • 70 percent of cases occur in the knee; elbow is second most frequent site
  • can manifest as insidious but intensifying pain (over years), crepitus and joint locking
  • two main forms: primary – apparently arises spontaneously, but recurrent microtrauma has been implicated; secondary – more common, and develops as a sequela to degenerative or neuropathic joint disease, osteochondritis dessicans, osteochondral fractures, or joint dislocations
  • differential diagnosis includes multiple sesamoid bones, pseudogout, synovioma, pigmented villonodular synovitis and chondrosarcoma
  • surgical removal is usually indicated, but recurrence is not uncommon

References:
Yochum TR, Rowe LJ.  Essentials of Skeletal Radiology.  1997, Williams & Wilkins, Baltimore.

A 1983 CMCC graduate, Dr. Marshall Deltoff completed his radiology residency at Los Angeles College of Chiropractic. He is a past radiology department chairman and residency coordinator at CMCC, and he initiated the radiology curriculum at UQTR. Dr. Deltoff has lectured throughout North America, and is co-author, along with Dr. Peter Kogon, DACBR, of the radiology text “The Portable Skeletal X-ray Library” published by Mosby-Yearbook of St. Louis. Dr. Deltoff can be reached at:

Images Radiology Consultants,
16 York Mills Road,
Toronto, Ont.  M2P 2E5
Tel: (416) 512-2225 
Fax: (416) 512-2226 
e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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