This report describes a case of cppd of the cervical spine which presents with symptoms of neck pain and brachalgia. The spine is frequently involved in cppd crystal deposition disease. Computed tomography dependent diagnosis of crowned dens. Terms used in the search included pseudogout, cppd, cds, chondocalcinosis and calcification. The bony segments that form the spine and protect the spinal cord. To our knowledge, the only study to date in which ct was used to determine the prevalence of cppd crystal deposition in the cervical spine was performed in 1995 by zapletal et al, who evaluated 700 consecutive patients undergoing ct of the brain or paranasal sinuses and found a prevalence of 8. Cppd crystal deposition in the cervical spine is seen with a higher. Calcium pyrophosphate dihydrate cppd crystal deposition disease is characterized by the. Melorheostosis leri disease is a rare nonhereditary sclerosing mesenchymal dysplasia of bone originally described more than 80 years ago. Calcium pyrophosphate dihydrate cppd crystal deposition disease is characterized by the accumulation of cppd crystals in articular and periarticular tissues. Ctscan was more sensitive than plain radiographs for detecting spinal calcifications. Sagittal reconstructed ct images of the cervical spine in bone a and soft tissue b windows demonstrate erosion and posterior remodeling of the dens asterisk with a peripherally calcified soft tissue mass in a halo or crownlike appearance solid white arrows. Calcium pyrophosphate dihydrate deposition disease. Trauma induced calcium pyrophosphate deposition disease of the.
She had inflammatory low back pain for a month with lowgrade fever and creactive protein crp up to 3 mgdl. Previous reports of spinal cppd have typically involved the cer vical and lumbar spines 1726. Patient with spinal involvement had more widespread peripheral cc. Lumbar spine chondrocalcinosis the journal of rheumatology.
Inflammatory arthritis, such as pseudogout or otherwise referred to as calcium pyrophosphate cpp crystal arthritis or calcium pyrophosphate deposition cppd disease, is characterized by the deposition of crystal formation and deposition in large joints. Expanding upon the core of the highly popular second edition this updated reference is fully revised to provide the best spine related diagnostic support available. We report a case of compressive cervical myelopathy due to cppd deposition disease of the cervical spine in a woman with longstanding rheumatoid arthritis. A similar retrospective analysis of 5 cervical spine ct scans in an adult. Cppd disease involving the spine has been infrequently encountered in practice and rarely.
Spine cervicomedullary compression secondary to massive calcium pyrophosphate crystal deposition in the atlantoaxial joint with intradural extension and vertebral artery encasement kanika s. Mri of the cervical spine revealed low signal intensity mass on. Pdf pseudogout is a form of acute calcium pyrophosphate deposition cppd disease that typically afflicts the elderly. Jun 01, 2019 spinal cppd was diagnosed in 37152 24. In case 2, there were calcifications of the trans verse ligament as described by dirheimer 6 in cppd crystal deposition disease, forestiers dis ease of the dorsal spine, mild degenerative disc disease of the l4l5 disc space and disc space fig. Radiographs and ct showed unilateral wellmarginated undulating zones of cortical hyperostosis involving multiple vertebrae that were contiguous with a coalescent ossified right paravertebral mass. Occasionally, atlantoaxial pannus is reported when patients without a history of ra undergo magnetic resonance imaging mri of the cervical spine.
A study was conducted in the rheumatology department of lariboisiere hospital in paris which attempted to find. Cppd crowned dens syndrome with clivus destruction. Temporomandibular joint tmj dysfunction causes pain and dysfunction in the jaw joint and muscles. Cervical myelopathy due to subaxial calcium pyrophosphate.
The diagnosis of cppd is supported by the presence of radiographic chondrocalcinosis. Cppd is known to affect the elderly population and commonly manifests as inflammation of knees, hips, and shoulders. Aug 16, 2018 about 65% of patients have articular cppd depositions within knee, wrist and ankle joints 2. Deposition cppd arthropathy pseudogout arthritis productive erosive. Cppd crystal deposition disease of the cervical spine.
Calcium pyrophosphate deposition cppd disease is a crystal arthropathy primarily affecting peripheral joints, most commonly the wrist and the knees. Terminology the terminology regarding cppd disease has been confusing, with chondrocalcinosis, cppd, and pseudogout often used synonymously. Mr imaging is also useful to assess spinal cord compression or myelopathy. Magnetic resonance imaging of the lumbar spine in people without back pain. Cppd deposition in the cervical spine is an unusual cause of cervical spinal cord compression and myelopathy.
Magnetic resonance imaging of the spine suggested a. To the best of our knowledge, cppd crystal deposition along the spinal dura mater has not been previously reported. 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. Pseudogout is a syndrome caused by the deposition of calcium pyro. Calcium pyrophosphate dihydrate cppd crystal deposition can occur in cartilage hyaline cartilage or fibrocartilage, ligaments, tendons, bursae, and joint capsules 1. A partially calcified mass is seen behind the odontoid process compressing the cervical cord, socalled periodontoid pseudotumor. Calcium pyrophosphate dihydrate cppd crystallization is known to occur in the spine, leading to the development of visible calcification as seen by imaging. Here, we present two unusual cases of cppd of the cervical and thoracolumbar spines. Acute neck pain caused by pseudogout attack of calcified. Calcification of the alar ligament of the cervical spine.
Cppd deposition on the cervical spine is less well known, and only a. Jun 07, 2018 abstract musculoskeletal calcifications are frequent on radiographs and sometimes problematic. Over 8000 researchers, developers, and entrepreneurs work closely together at the htc, developing the technologies and products of tomorrow. Indeed, although initially described as chondrocalcinosis articularis, it is now understood that imaging findings of chondrocalcinosis do not always indicate cppd disease 9 in response, in 2011 the european league against rheumatism. The patient endorsed loss of manual dexterity, gait impairment, and difficulty with. A 70yearold woman with a recent sigmoid diverticulitis was examined for a suspicion of infectious spondylodiscitis. The cervical involvement in crystalassociated diseases may provoke a misleading clinical presentation. Some patients develop the diagnosis of cppd in periodontoid location. Pdf cervicomedullary compression secondary to massive. Imagingingoutand other crystalrelated arthropathies. Crystal deposition in and around joints, and tendons. One should first differentiate a calcification from an ossification or a foreign body and then locate the calcification correctly. In this article, we focus on the three common crystals and diseases. Indeed, although initially described as chondrocalcinosis articularis, it is now understood that imaging findings of chondrocalcinosis do not always indicate cppd disease 9.
Calcium pyrophosphate dihydrate cppd disease or pseudogout of the cervical spine. Mar 12, 2015 calcium pyrophosphate deposition disease cppd is a common and clinically heterogeneous form of arthritis caused by the deposition of calcium pyrophosphate cpp crystals in articular tissues. Magnetic resonance imaging mri of the cervical spine revealed bone. The clinical spectrum of crowned dens syndrome proceedings. Figure 2 from cppd crowned dens syndrome with clivus. The imaging findings of tophi on t2w images are variable, but usually contain lowsignal intensities. Oct 31, 2020 cppd deposition is a crystal arthropathy primarily affecting the peripheral joints, most commonly the wrist and knee. The cervical spine may be specifically involved in crystalassociated.
Compressive cervical myelopathy due to calcium pyrophosphate. The inferior portion of the clivus is destroyed solid black arrows. Trauma induced calcium pyrophosphate deposition disease of. Cervical spine disease due to cppd deposition is, however, rare. Expanding upon the core of the highly popular second edition, this updated reference is fully revised to provide the best spine.
Cervical ct is the gold standard imaging modality in that it can show irregular calcifications crowning the dens apex and bone erosions of the dens 3. Pseudogout of the cervical and thoracic spine mimicking infection. Musculoskeletal radiology cppd crowned dens syndrome. Expanding upon the core of the highly popular second edition this updated reference is fully revised to provide the best spine. He had worsening pain and radiculopathy, and imaging.
Apr 23, 2005 the cervical spine may be specifically involved in crystalassociated arthropathies. Imaging of calcium pyrophosphate deposition disease. Musculoskeletal radiology cppd crowned dens syndrome with. Calcium pyrophosphate deposition cppd disease bpj 55. Most of the cases are related to cppd or hydroxyapatite crystal. Calcium pyrophosphate deposition disease of the cervical and.
It is an open campus, targeted at fostering open cooperation between different companies and institutes. Spinal pseudogout is a rare entity, with few case reports described in the literature, most of which depict pseudogout of the cervical region. To our knowledge, the only study to date in which ct was used to determine the prevalence of cppd crystal deposition in the cervical spine was performed in 1995 by zapletal et al 25, who evaluated 700 consecutive patients undergoing ct of the brain or paranasal sinuses and found a prevalence of 8. Intervertebral discal calcifications are frequent in the outer annular fibers, and may mimic early syndesmophytes of ankylosing spondylitis, because of their vertical orientation and slender appearance. Serum urate exceeding the physiologic saturation threshold 380 mmoll. L spine 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. Imaging of calcium pyrophosphate deposition disease ncbi nih. Calcium pyrophosphate dihydrate crystal deposition disease of. 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. Magnetic resonance imaging and computed tomography in the ev. Posterior c1c2 calcium pyrophosphate dihydrate crystal deposition. However, cppd in the cervical spine is a rare entity. Cppd deposition in the cervical spine has been previously described and. The cervical n 21 and lumbar n 19 segments were most involved.
Essentials with joint space narrowing, it is important to differentiate in. Cppd crystal deposition is associated with many diseases, including inherited or acquired metabolic diseases such as hemochromatosis and hyperparathyroidism 2, 3. Imaging in gout and other crystalrelated arthropathies european. Pannus formation in the atlantoaxial joint is a wellrecognized complication of rheumatoid arthritis ra. Chondrocelcinosis, arthropathyandjointpain are the hallmarks ofthe cppd crystaldeposition disease or pseudogoutsyndrome.
P seudogout is a widely recognized form of acute calcium pyrophosphate deposition cppd disease, presenting as acute arthritis of monoarticular or oligoarticular joints. An xray of the knees alone is likely to result in a significant number of patients with cppd being missed. Spinal immobilization is a priority in multiple trauma, spinal clearance is not 2. American spine society, the american society of spine radiology and the american society of neuroradiology david f. Spinal cppd is uncommon, and often resembles more common spine pathologies causing pain and neural compression 216. Spine location of injury jefferson c1 lateral masses hangman c2 pars fx clay shovelers posterior elements. Cppd calcium pyrophosphate dihydrate authors stated no. However, cppd deposition in the cervical spine is a rare entity 1,2,3,4,5,6,7. Musculoskeletal radiology radiology, news, education. Magnetic resonance imaging mri without contrast again demonstrated th.
Jan 01, 2000 radiology of spinal cppd deposition disease the radiological findings in this condition have been adequately described 3, 28, 30. These mass lesions were reported to be references diagnosed with a high degree of certainty preoperatively using standard imaging techniques and can be. Cureus updated treatment for calcium pyrophosphate. Calcium pyrophosphate dihydrate crystal deposition. Spine, now in its third edition, showcases the latest cuttingedge research from dr. The goal of this article is to help radiologists to make the correct diagnosis when faced with an extraosseous musculoskeletal calcification. The partners healthcare research patient data registry was freetext. Cppd in the spine is an uncommon diagnosis but should be considered in the. These include oval calcified nodules in the posterior aspect of the spinal canal near the ligamentum flavum or both punctate calcifications and enlargement of the ligamentum flavum 28.
Spine now in its third edition showcases the latest cuttingedge research from dr. Melorheostosis, an uncommon mesenchymal dysplasia, rarely affects the axial skeleton. Melorheostosis involving the cervical and upper thoracic. Frequency of atlantoaxial calcium pyrophosphate dihydrate. Cppd commonly involves larger joints, such as the knees, wrists, shoulders, and hips, and has been known to involve the spine. Cppd in the spine include calcium deposition within the supraspinous and interspinous ligaments, anterior and posterior longitudinal ligaments, intervertebral discs, and joint capsule. Here, we present a case of cppd crystal deposition disease in the ligamentum flavum of the cervical spine that showed intense enhancement. On day 3, interventional radiology ir imageguided biopsy and aspiration of the l4l5 vertebral bone was done. Philips research eindhoven is located on the high tech campus htc eindhoven, which is the center for technology enabled innovation in the netherlands. In cases of small foci with lowlevel enhancement, this may correspond to calcification, fibrosis, or hemosiderin within. Cppd crystal deposition disease or pseudogout clyde a. Calcium pyrophosphate dihydrate crystal deposition disease.
Despite many case reports, extraarticular cppd deposits often go unrecognized. Gout crystal arthropathy calcification imaging radiography ultrasound. Cppd crystals were often found in lumbar disc specimens and in spinal ligaments. Calcium pyrophosphate dihydrate deposition disease causing. Imaging the spine does not take precedence over life saving diagnostic and therapeutic procedures. Spinal involvement with calcium pyrophosphate deposition. Pseudogout of the cervical and thoracic spine mimicking. Occasionally, the deposition of this material can lead to larger accumulations that are seen as masses in the articular processes, intervertebral discs, and posterior longitudinal ligaments.
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