The X Files - october 2008

Marshall Deltoff
October 29, 2008
Written by Marshall Deltoff
A 62-year-old woman presented with bilateral knee crepitus, swelling and stiffness. Radiographic examination reveals bilateral chondrocalcinosis. (Figures A and B)

Diagnosis: Calcium pyrophosphate dihydrate (CPPD) deposition disease; also known as pseudogout.

 page42  page42a
 Figure A
 Figure B

Some points to remember about CPPD:
  • inflammatory joint disease resulting from deposition of calcium pyrophosphate dihydrate into the synovial fluid; a metabolic disturbance in which there is an  impaired degradation or excessive production of pyrophosphate
  • may be acute (more prevalent in males) or chronic (more prevalent in females)
  • frequently associated with diabetes mellitus
  • features include articular cartilage calcification, with possible periarticular calcification of synovium, articular capsule, tendons, bursae
  • affected hyaline cartilage appears as a fine radiopaque line parallel to the contour of the articular cortex
  • affected fibrocartilage demonstrates a characteristic punctate calcification
  • in the knee, the menisci classically demonstrate calcification
  • joint destruction associated with CPPD is virtually indistinguishable from that of osteoarthritis
  • CPPD also tends to affect the shoulder, elbow, radiocarpal joint, hip, symphysis pubis and patellofemoral joint
  • joint aspiration may be necessary to confirm the diagnosis •

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