(2,3) CPPD, HADD & Ochronosis/Alkaptonuria & Miscellaneous Flashcards
What is another name for CPPD crystal deposition disease?
pseudogout
What age group is primarily affected by CPPD deposition disease?
> 50 yrs
What is the term for the radiographic finding of crystalline deposits in articular cartilage?
chondrocalcinosis
What are the clinical manifestations of CPPD deposition disease?
- many cases asymptomatic (early stage)
- bilateral asymmetric
- acute inflamed joint (big, red, swollen)
What are the target sites of CPPD?
- knee
- symphysis pubis
- hand & wrist
- hip
- shoulder
- elbow
- spine
What are the radiographic findings of CPPD?
- chondrocalcinosis
- soft tissue swelling
- rapid severe degeneration (large subchondral cysts)
- pyrophosphate arthropathy (complication)
- articular destruction
- SLAC wrist (complication)
What does HADD stand for?
(calcium) hydroxyapatite deposition disease
What are other names for HADD?
- calcific tendinosis
- calcific bursitis
What tissues can HADD deposit into?
- bursa
- ligaments
- tendons
(“hadd a BLT”)
How can you differentiate between CPPD and HADD radiographically?
CPPD involves cartilage, HADD does not
What are the target sites of HADD?
shoulder (rotator cuff; MC)
hip
c/s
What is the radiographic pattern of HADD in supraspinatus?
seen in profile on ext. rot. adjacent to greater tuberosity
What is the radiographic pattern of HADD in infraspinatus?
seen in profile on int. rot. adjacent to greater tuberosity
What is the radiographic pattern of HADD in subscapularis?
seen in profile on int. rot. adjacent to lesser tuberosity
What is Pellegrini-Steida?
calcification at femoral attachment of MCL in knee
(seen in HADD)
What tissue in the c-spine is HADD commonly found?
longus coli tendon at inferior attachment of ant arch of C1
What is the radiographic pattern of HADD in intervertebral discs?
- annulus fibrosis: intercalary bone
- nucleus pulposus
A 55 year old male has bilateral knee pain, redness, and swelling for many years. The pain comes and goes, with the interval between flare-ups shortening and the episodes lengthening. Radiographs reveal chondrocalcinosis of the menisci and moderate degenerative changes. What is the most likely diagnosis?
CPPD
Ochronosis/Alkaptonuria results from the absence of ____
homogentisic acid oxidase
What is Ochronosis?
homogentisic acid deposited in tissues
What is Alkaptonuria?
homogentisic acid excreted in urine
What are the clinical features of Ochronosis/Alkaptonuria?
- brown-black urine discolouration on standing (when oxidized)
- bluish-brown pigmentation of skin, eyes, nose, and ear cartilages
Ochronosis/Alkaptonuria is autosomal ____
recessive
What are the radiographic features of Ochronosis/Alkaptonuria?
- multiple disc calcification (white disc, black piss)
- loss of disc space
- vacuum phenomenon
- eventual ankylosis (similar appearance to AS)
- advanced DJD
- chondrocalcinosis
What sex is primarily affected by Osteitis Condensans ilii?
F>M (9:1)
Osteitis Condensans ilii occurs secondary to ____
mechanical stress (eg. pregnancy)
What are the clinical features of Osteitis Condensans ilii?
- may simulate seroneg. Dz’s b/c of inflammatory SI pain
- bilateral or unilateral
- natural Hx of 6 months
What are the clinical features of Osteitis pubis?
(uncommon)
- non-suppurative inflammation
- Hx of pelvic surgery, childbirth, trauma (marathon runners)
How would you differentiate CPPD from Gout if your patient presents with 1 big red swollen joint?
- labs: hyperuricemia = gout
- gout uncommon in knee
- radiographs
What population is commonly affected by osteitis condensans ilii (OCI)?
Multiparous, post-partum women
Describe the radiographic appearance of OCI.
(Need Ferguson’s view)
- Dense triangular sclerosis just inferior to SI joint
- clean SI jt margins
What treatment does OCI respond well to?
Adjustment (but tends to flare up Sx)
What treatment does Osteitis pubis respond well to?
Stabilization (trochanter belt)
What are the radiographic characteristics of Osteitis pubis?
- subchondral sclerosis of pubic body
- wide jt space (erosion)
