Difference between revisions of "Chondrocalcinosis"

Chondrocalcinosis
	Diagnosis in short
	; Chondrocalcinosis. H&E stain.
Synonyms	calcium pyrophosphate dihydrate deposition disease, calcium pyrophosphate deposition, pseudogout (old term)
LM	crystals with a rhomboid-shape; polarized light: positively birefringent, blue when aligned
LM DDx	benign calcifications, osteoarthritis
Gross	+/-subchondral cysts, degeneration of cartilage
Site	joints - especially knee
Symptoms	joint pain
Prevalence	uncommon
Radiology	+/-loose bodies, joint space narrowing, narrowing of patellofemoral joint
Prognosis	benign
Clin. DDx	osteoarthritis, other types of arthritis

Latest revision as of 10:58, 24 April 2014

Chondrocalcinosis, also calcium pyrophosphate deposition and calcium pyrophosphate dihydrate deposition disease (abbreviated CPPD),^[1] is a benign condition of the joints.

It was previously known as pseudogout.^[2]

General

Classically found in the knee.
Associated with low bone mineral density and vascular calcification.^[3]

Gross

Degeneration of cartilage.
Subchondral sclerosis.

Radiology

Similar to osteoarthritis - joint space narrowing & subchondral sclerosis.^[4]

Findings suggestive of CPPD:^[4]

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

www:

Pseudogout (highwire.org).^[5]

Sign-out

KNEE - BONE AND SOFT TISSUE, RIGHT, KNEE ARTHROPLASTY:
- DEGENERATIVE JOINT DISEASE WITH SYNOVIAL HYPERPLASIA AND 
  NO SIGNIFICANT INFLAMMATION.
- CRYSTALLINE DEPOSITS CONSISTENT WITH PSEUDOGOUT.
- BONE WITH THIN TRABECULAE.

BONE, LEFT KNEE, JOINT REPLACEMENT:
- DEGENERATIVE JOINT DISEASE.
- CRYSTALS CONSISTENT WITH PSEUDOGOUT.
- SYNOVIAL HYPERPLASIA WITH RARE GIANT CELLS.
- NEGATIVE FOR MALIGNANCY.

FEMORAL HEAD AND JOINT CAPSULE, LEFT, HIP ARTHROPLASTY:
- DEGENERATIVE JOINT DISEASE WITH MILD LYMPHOPLASMACYTIC INFLAMMATION.
- CRYSTALLINE DEPOSITS CONSISTENT WITH CHONDROCALCINOSIS.
- NEGATIVE FOR MALIGNANCY.

Micro

The soft tissue section shows readily apparent rhomboid-shaped crystalline deposits (compatible with pseudogout). The crystals polarize and have a light blue hue under polarized light. Synovial hyperplasia is present. No lymphoid aggregates are apparent.

The bony section show thin bony trabeculae and cartilage with degenerative changes (surface fibrillation, thinning).

References

↑ URL: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/. Accessed on: 28 October 2011.
↑ URL: http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/pseudogout.asp. Accessed on: 12 March 2014.
↑ 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.
↑ ^4.0 ^4.1 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/.

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

[2] URL: http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/pseudogout.asp. Accessed on: 12 March 2014.

[pmid23912799-3] 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-4] 4.0 ^4.1 URL: http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm. Accessed on: 9 October 2013.

[pmid10225806-5] 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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@@ Line 1: / Line 1: @@
-#redirect [[Crystals in body fluids#Pseudogout]]
+{{ Infobox diagnosis
+| Name       = {{PAGENAME}}
+| Image      = Pseudogout_-_very_high_mag.jpg
+| Width      =
+| Caption    = Chondrocalcinosis. [[H&E stain]].
+| Synonyms   = calcium pyrophosphate dihydrate deposition disease, calcium pyrophosphate deposition, pseudogout (old term)
+| Micro      = crystals with a rhomboid-shape; polarized light: positively birefringent, blue when aligned
+| Subtypes   =
+| LMDDx      = benign calcifications, [[osteoarthritis]]
+| Stains     =
+| IHC        =
+| EM         =
+| Molecular  =
+| IF         =
+| Gross      = +/-subchondral cysts, degeneration of cartilage
+| Grossing   =
+| Site       = [[joints]] - especially knee
+| Assdx      =
+| Syndromes  =
+| Clinicalhx =
+| Signs      =
+| Symptoms   = joint pain
+| Prevalence = uncommon
+| Bloodwork  =
+| Rads       = +/-[[loose bodies]], joint space narrowing, narrowing of patellofemoral joint
+| Endoscopy  =
+| Prognosis  = benign
+| Other      =
+| ClinDDx    = [[osteoarthritis]], other types of [[arthritis]]
+| Tx         =
+}}
+'''Chondrocalcinosis''', also '''calcium pyrophosphate deposition''' and '''calcium pyrophosphate dihydrate deposition disease''' (abbreviated '''CPPD'''),<ref>URL: [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/]. Accessed on: 28 October 2011.</ref> is a benign condition of the [[joints]].
+It was previously known as '''pseudogout'''.<ref>URL: [http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/pseudogout.asp http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/pseudogout.asp]. Accessed on: 12 March 2014.</ref>
+==General==
+*Classically found in the knee.
+*Associated with low bone mineral density and vascular calcification.<ref name=pmid23912799>{{Cite journal  | last1 = Abhishek | first1 = A. | last2 = Doherty | first2 = S. | last3 = Maciewicz | first3 = R. | last4 = Muir | first4 = K. | last5 = Zhang | first5 = W. | last6 = Doherty | first6 = M. | title = Association between low cortical bone mineral density, soft-tissue calcification, vascular calcification and chondrocalcinosis: a case-control study. | journal = Ann Rheum Dis | volume =  | issue =  | pages =  | month = Aug | year = 2013 | doi = 10.1136/annrheumdis-2013-203400 | PMID = 23912799 }}</ref>
+==Gross==
+*Degeneration of cartilage.
+*Subchondral sclerosis.
+===Radiology===
+*Similar to [[osteoarthritis]] - joint space narrowing & subchondral sclerosis.<ref name=learningrads>URL: [http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm]. Accessed on: 9 October 2013.</ref>
+Findings suggestive of CPPD:<ref name=learningrads>URL: [http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm]. Accessed on: 9 October 2013.</ref>
+*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+'' = ''a''ligned ''b''lue is ''c''alcium & ''c''uboid - positively birefringent.
+===Images===
+<gallery>
+Image: Pseudogout - low mag.jpg | Pseudogout - low mag. (WC)
+Image:Pseudogout_-_intermed_mag.jpg | Pseudogout - intermed. mag. (WC)
+Image:Pseudogout_-_high_mag.jpg | Pseudogout - high mag. (WC)
+Image:Pseudogout_-_very_high_mag.jpg | Pseudogout - very high mag. (WC)
+</gallery>
+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
+  NO SIGNIFICANT INFLAMMATION.
+- CRYSTALLINE DEPOSITS CONSISTENT WITH PSEUDOGOUT.
+- BONE WITH THIN TRABECULAE.
+</pre>
+<pre>
+BONE, LEFT KNEE, JOINT REPLACEMENT:
+- DEGENERATIVE JOINT DISEASE.
+- CRYSTALS CONSISTENT WITH PSEUDOGOUT.
+- SYNOVIAL HYPERPLASIA WITH RARE GIANT CELLS.
+- NEGATIVE FOR MALIGNANCY.
+</pre>
+<pre>
+FEMORAL HEAD AND JOINT CAPSULE, LEFT, HIP ARTHROPLASTY:
+- DEGENERATIVE JOINT DISEASE WITH MILD LYMPHOPLASMACYTIC INFLAMMATION.
+- CRYSTALLINE DEPOSITS CONSISTENT WITH CHONDROCALCINOSIS.
+- NEGATIVE FOR MALIGNANCY.
+</pre>
+===Micro===
+The soft tissue section shows readily apparent rhomboid-shaped crystalline deposits
+(compatible with pseudogout). The crystals polarize and have a light blue hue under
+polarized light. Synovial hyperplasia is present. No lymphoid aggregates are apparent.
+The bony section show thin bony trabeculae and cartilage with
+degenerative changes (surface fibrillation, thinning).
+==See also==
+*[[Joints]].
+*[[Crystals in body fluids]].
+==References==
+{{Reflist|2}}
+[[Category:Crystals in body fluids]]
+[[Category:Diagnosis]]