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).
Figure A |
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: marshdel@rogers.com
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