Revision as of 12:13, 9 October 2013

This article deals with crystals in body fluids.

Crystals

Joint crystals

Types:^[1]

Gout = needle-shaped, negatively birefringent, yellow when aligned.
Pseudogout = rhomboid-shaped, positively birefringent, blue when aligned.

Notes:

Pseudogout also known as CPPD = calcium pyrophosphate dehydrogenase.
Memory device: ABC+ = aligned blue is calcium & cuboid - positively birefringent.

Urine crystals

Types - morphology:

Envelope shape (calcium oxalate).
Diamond shape (uric acid).
Coffin-lid shape (struvite).
Hexagonal shape (cysteine).

Notes:

Memory devices:
- Diamonds are see-through; ergo, uric acid stones not seen on KUB.
- Calcium oxalate = envelope, uric acid = diamond.
Uric acid crystals: usually dissolve in formalin... but do not dissolve in alcohol.^[2]
Calcium oxalate crystals are seen in the context of ethylene glycol poisoning.^[3]

Diseases

Gout

General

Classically afflicts the big toe - known as podagra.

Etiology:^[4]

Overproduction of uric acid ~ 10% of cases.
Reduced excretion of uric acid ~ 90% of cases.
- May be genetic, e.g. URAT1 mutation.^[5]^[6]
- Renal failure.

Gross/radiology

Radiologically may mimic anconeus epitrochlearis muscle.^[7]

Microscopic

Features:^[8]

Tophi (advanced)
- Reactive granulomatous inflammation.
  - Surrounds fluffy (cotton candy-like) material.
- Fibrotic synovium.
- Aggregates of urate crystals.

Images:

Pseudogout

Chondrocalcinosis redirects here.

AKA Calcium pyrophosphate dihydrate deposition disease,^[9] abbreviated CPPD.

General

Classically found in the knee.
Associated with low bone mineral density and vascular calcification.^[10]

Radiology

Similar to osteoarthritis - joint space narrowing & subchondral sclerosis.^[11]

Findings suggestive of CPPD:^[11]

Subchondral cysts (large) - important.
Intra-articular bodies, several.
Increased narrowing of patellofemoral joint.

Microscopic

Features:

Crystals with a rhomboid-shape.
- Positively birefringent, blue when aligned.

Notes:

Memory device: ABC+ = aligned blue is calcium & cuboid - positively birefringent.

Images

Pseudogout - intermed. mag. (WC)
Pseudogout - high mag. (WC)

www:

Pseudogout (highwire.org).^[12]

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KNEE - BONE AND SOFT TISSUE, RIGHT, KNEE ARTHROPLASTY:
- DEGENERATIVE JOINT DISEASE WITH SYNOVIAL HYPERPLASIA AND MINIMAL INFLAMMATION.
- CRYSTALLINE DEPOSITS CONSISTENT WITH PSEUDOGOUT.
- BONE WITHOUT APPARENT PATHOLOGY.

Micro

Readily apparent rhomboid-shaped crystalline deposits are present (compatible with pseudogout). The crystals polarize and have a light blue hue under polarized light.

References

↑ Yeung, J.C.; Leonard, Blair J. N. (2005). The Toronto Notes 2005 - Review for the MCCQE and Comprehensive Medical Reference (2005 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. RH6. ISBN 978-0968592854.
↑ WG. 8 January 2010.
↑ Saukko, Pekka; Knight, Bernard (2004). Knight's Forensic Pathology (3rd ed.). A Hodder Arnold Publication. pp. 589. ISBN 978-0340760444.
↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 634. ISBN 978-1416054542.
↑ Online 'Mendelian Inheritance in Man' (OMIM) 607096
↑ Tin, A.; Woodward, OM.; Kao, WH.; Liu, CT.; Lu, X.; Nalls, MA.; Shriner, D.; Semmo, M. et al. (Oct 2011). "Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele.". Hum Mol Genet 20 (20): 4056-68. doi:10.1093/hmg/ddr307. PMID 21768215.
↑ URL: http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213. Accessed on: 7 August 2011.
↑ URL: http://pathologyoutlines.com/joints.html#gout. Accessed on: 5 August 2011.
↑ URL: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/. Accessed on: 28 October 2011.
↑ Abhishek, A.; Doherty, S.; Maciewicz, R.; Muir, K.; Zhang, W.; Doherty, M. (Aug 2013). "Association between low cortical bone mineral density, soft-tissue calcification, vascular calcification and chondrocalcinosis: a case-control study.". Ann Rheum Dis. doi:10.1136/annrheumdis-2013-203400. PMID 23912799.
↑ ^11.0 ^11.1 URL: http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm. Accessed on: 9 October 2013.
↑ Dieppe, P.; Swan, A. (May 1999). "Identification of crystals in synovial fluid.". Ann Rheum Dis 58 (5): 261-3. PMC 1752883. PMID 10225806. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1752883/.

External links

Foreign body granulomas (granuloma.homestead.com).

[1] Yeung, J.C.; Leonard, Blair J. N. (2005). The Toronto Notes 2005 - Review for the MCCQE and Comprehensive Medical Reference (2005 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. RH6. ISBN 978-0968592854.

[2] WG. 8 January 2010.

[Ref_KFP589-3] Saukko, Pekka; Knight, Bernard (2004). Knight's Forensic Pathology (3rd ed.). A Hodder Arnold Publication. pp. 589. ISBN 978-0340760444.

[Ref_PCPBoD8-4] Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 634. ISBN 978-1416054542.

[omim607096-5] Online 'Mendelian Inheritance in Man' (OMIM) 607096

[6] Tin, A.; Woodward, OM.; Kao, WH.; Liu, CT.; Lu, X.; Nalls, MA.; Shriner, D.; Semmo, M. et al. (Oct 2011). "Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele.". Hum Mol Genet 20 (20): 4056-68. doi:10.1093/hmg/ddr307. PMID 21768215.

[7] URL: http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213. Accessed on: 7 August 2011.

[8] URL: http://pathologyoutlines.com/joints.html#gout. Accessed on: 5 August 2011.

[9] URL: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/. Accessed on: 28 October 2011.

[pmid23912799-10] Abhishek, A.; Doherty, S.; Maciewicz, R.; Muir, K.; Zhang, W.; Doherty, M. (Aug 2013). "Association between low cortical bone mineral density, soft-tissue calcification, vascular calcification and chondrocalcinosis: a case-control study.". Ann Rheum Dis. doi:10.1136/annrheumdis-2013-203400. PMID 23912799.

[learningrads-11] 11.0 ^11.1 URL: http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm. Accessed on: 9 October 2013.

[pmid10225806-12] Dieppe, P.; Swan, A. (May 1999). "Identification of crystals in synovial fluid.". Ann Rheum Dis 58 (5): 261-3. PMC 1752883. PMID 10225806. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1752883/.

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Difference between revisions of "Crystals in body fluids"

Revision as of 12:13, 9 October 2013

Contents

Crystals

Joint crystals

Urine crystals

Diseases

Gout

General

Gross/radiology

Microscopic

Pseudogout

General

Radiology

Microscopic

Images

Sign-out

Micro

See also

References

External links

Navigation menu

Search

@@ Line 83: / Line 83: @@
 www:
 *[http://ard.highwire.org/content/58/5/261/F2.large.jpg Pseudogout (highwire.org)].<ref name=pmid10225806>{{Cite journal  | last1 = Dieppe | first1 = P. | last2 = Swan | first2 = A. | title = Identification of crystals in synovial fluid. | journal = Ann Rheum Dis | volume = 58 | issue = 5 | pages = 261-3 | month = May | year = 1999 | doi =  | PMID = 10225806 | PMC = 1752883 | URL = http://ard.highwire.org/content/58/5/261.full }}</ref>
+===Sign-out===
+<pre>
+KNEE - BONE AND SOFT TISSUE, RIGHT, KNEE ARTHROPLASTY:
+- DEGENERATIVE JOINT DISEASE WITH SYNOVIAL HYPERPLASIA AND MINIMAL INFLAMMATION.
+- CRYSTALLINE DEPOSITS CONSISTENT WITH PSEUDOGOUT.
+- BONE WITHOUT APPARENT PATHOLOGY.
+</pre>
+====Micro====
+Readily apparent rhomboid-shaped crystalline deposits are present (compatible with
+pseudogout). The crystals polarize and have a light blue hue under polarized light.
 =See also=