Difference between revisions of "Crystals in body fluids"

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[[Image:Gout_-_monosodium_urate_crystals_(20X,_polarized,_red_compensator).jpg|thumb|right|Crystals (gout) and blood cells in [[polarized light]]. (WC/Gabriel Caponetti)]]
[[Image: Crystals in urine - uc -- very high mag - animation.gif | Crystals - very high mag.|thumb|right|Crystals in urine. (WC)]]
This article deals with '''crystals in body fluids'''.
This article deals with '''crystals in body fluids'''.


=Crystals=
=Crystals=
==Joint crystals==
==Joint crystals==
Types:<ref>TN05 RH6</ref>
Types:<ref>{{Ref TN2005| RH6}}</ref>
*Gout = needle-shaped, negatively birefringent, yellow when aligned.
*Gout = needle-shaped, negatively birefringent, yellow when aligned.
*Pseudogout = rhomboid-shaped, positively birefringent, blue when aligned.
*Pseudogout = rhomboid-shaped, positively birefringent, blue when aligned.
Line 10: Line 12:
*Pseudogout also known as CPPD = calcium pyrophosphate dehydrogenase.
*Pseudogout also known as CPPD = calcium pyrophosphate dehydrogenase.
*Memory device: ''ABC+'' = ''a''ligned ''b''lue is ''c''alcium & ''c''uboid - positively birefringent.
*Memory device: ''ABC+'' = ''a''ligned ''b''lue is ''c''alcium & ''c''uboid - positively birefringent.
Images:
*[http://www.stpetes.org/html/pointofcare/Procedures/Blue%20(Addition).jpg Crystals - schematic (stpetes.org)] from ''[http://www.stpetes.org/html/pointofcare/Procedures/crystals.html Microscopic Examination for Crystals in Synovial Fluid (stpetes.org)]''.
*[http://library.med.utah.edu/WebPath/COW/COW197.html Blue rhomboid CPPD crystals (med.utah.edu)].


==Urine crystals==
==Urine crystals==
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*Diamond shape (uric acid).  
*Diamond shape (uric acid).  
*Coffin-lid shape (struvite).
*Coffin-lid shape (struvite).
*Hexagonal shape (cysteine).
*Hexagonal shape ([[cystinosis|cysteine]]).


Notes:
Notes:
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**''Diamonds'' are see-through; ergo, uric acid stones not seen on KUB.
**''Diamonds'' are see-through; ergo, uric acid stones not seen on KUB.
**Calcium oxalat'''e''' = '''e'''nvelope, uric aci'''d''' = '''d'''iamond.
**Calcium oxalat'''e''' = '''e'''nvelope, uric aci'''d''' = '''d'''iamond.
*Uric acid crystals: usually dissolve in [[formalin]]... but do not dissolve in alcohol.<ref>WG. 8 January 2010.</ref>
*Uric acid crystals: usually dissolve in [[formalin]]... but do not dissolve in alcohol.<ref>Geddie, W. 8 January 2010.</ref><ref>{{Cite journal  | last1 = Shidham | first1 = V. | last2 = Chivukula | first2 = M. | last3 = Basir | first3 = Z. | last4 = Shidham | first4 = G. | title = Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis. | journal = Mod Pathol | volume = 14 | issue = 8 | pages = 806-10 | month = Aug | year = 2001 | doi = 10.1038/modpathol.3880394 | PMID = 11504841 }}</ref>
*Calcium oxalate crystals are seen in the context of [[ethylene glycol]] poisoning.<ref name=Ref_KFP589>{{Ref KFP|589}}</ref>
*Calcium oxalate crystals are seen in the context of [[ethylene glycol]] poisoning.<ref name=Ref_KFP589>{{Ref KFP|589}}</ref>


=Diseases=
===Images===
==Gout==
<gallery>
===General===
Image:Struvite_crystals_dog_with_scale_1.JPG | Struvite crystals. (WC)
*Classically big toe.
Image: Uric acid crystals (urine) - Ürik asit kristalleri (idrar) - 03.png | Uric acid crystals. (WC)
Image: Calcium oxalate crystals in urine.jpg | Calcium oxalate crystal - envelope-shaped. (WC)
Image: Fluorescent uric acid.JPG | Uric acid crystals. (WC)
</gallery>
====Case====
<gallery>
Image: Crystals in urine - uc -- high mag.jpg | Crystals - high mag.
Image: Crystals in urine - uc - alt -- high mag.jpg | Crystals - high mag.


===Gross/radiology===
Image: Crystals in urine - uc -- very high mag.jpg | Crystals - very high mag.
*Radiologically may mimic ''anconeus epitrochlearis'' muscle.<ref>URL: [http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213 http://radiology.casereports.net/index.php/rcr/article/viewArticle/57/213]. Accessed on: 7 August 2011.</ref>
Image: Crystals in urine - uc - alt -- very high mag.jpg | Crystals - very high mag.
Image: Crystals in urine - uc - alt 2 -- very high mag.jpg | Crystals - very high mag.
</gallery>
====www====
*[https://en.wikipedia.org/wiki/File:Uric_acid_crystals.jpg Uric acid crystals - schematic from 1844. (wikipedia.org)]


===Microscopic===
===Sign out===
Features:<ref>URL: [http://pathologyoutlines.com/joints.html#gout http://pathologyoutlines.com/joints.html#gout]. Accessed on: 5 August 2011.</ref>
====Urine cytology====
*Tophi (advanced)
<pre>
**Aggregates of urate crystals.
Negative for malignant cells.
**Reactive granulomatous inflammation.
Mainly squamous cells present. Cuboidal/rhomboidal crystals present.
**Fibrotic synovium.
</pre>


Images:
=Diseases=
*[http://www.archivesofpathology.org/na101/home/literatum/publisher/pinnacle/journals/content/arpa/2002/15432165-126.5/0003-9985%282002%29126%3C0621%3Apqcast%3E2.0.co%3B2/production/images/large/i1543-2165-126-5-621-f01.jpeg Gouty tophus - A. xray, B. Diff-Quick, C. Pap smear, D. polarized light, E. H&E (archivesofpathology.org)].
==Gout==
*[http://commons.wikimedia.org/wiki/File:Gouty_tophus_-_low_mag.jpg Gouty tophus - low mag. (WC)].
{{Main|Gout}}
*[http://commons.wikimedia.org/wiki/File:Gouty_tophus_-_high_mag.jpg Gouty tophus - high mag. (WC)].


==Pseudogout==
==Pseudogout==
*[[AKA]] ''calcium pyrophosphate dehydrogenase'', abbreviated ''CPPD''.
*[[AKA]] ''Calcium pyrophosphate dihydrate deposition disease'',<ref>URL: [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/]. Accessed on: 28 October 2011.</ref> abbreviated ''CPPD''.
===General===
{{Main|Chondrocalcinosis}}
*Classically found in the knee.
 
===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.


=See also=
=See also=
*[[Cytopathology]].
*[[Cytopathology]].
*[[Medical renal diseases]].
*[[Medical renal diseases]].
*[[Nephrolithiasis]] - kidney stones.
*[[Polarized light]].


=References=
=References=
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=External links=
=External links=
*[http://granuloma.homestead.com/foreignbody2.html Foreign body granulomas (granuloma.homestead.com)].
*[http://granuloma.homestead.com/foreignbody2.html Foreign body granulomas (granuloma.homestead.com)].
*[http://www.eclinpath.com/atlas/urinalysis/urine-crystals/nggallery/page/3 Urine cytology - veterinary medicine (eclinpath.com)].


[[Category:Clinical]]
[[Category:Clinical]]

Latest revision as of 04:58, 24 April 2016

Crystals (gout) and blood cells in polarized light. (WC/Gabriel Caponetti)
Crystals in urine. (WC)

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][3]
  • Calcium oxalate crystals are seen in the context of ethylene glycol poisoning.[4]

Images

  • Struvite crystals. (WC)

  • Uric acid crystals. (WC)

  • Calcium oxalate crystal - envelope-shaped. (WC)

  • Uric acid crystals. (WC)

Case

  • Crystals - high mag.

  • Crystals - high mag.

  • Crystals - very high mag.

  • Crystals - very high mag.

  • Crystals - very high mag.

www

Sign out

Urine cytology

Negative for malignant cells.
Mainly squamous cells present. Cuboidal/rhomboidal crystals present.

Diseases

Gout

Main article: Gout

Pseudogout

  • AKA Calcium pyrophosphate dihydrate deposition disease,[5] abbreviated CPPD.
Main article: Chondrocalcinosis

See also

References

  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. ↑ Geddie, W. 8 January 2010.
  3. ↑ Shidham, V.; Chivukula, M.; Basir, Z.; Shidham, G. (Aug 2001). "Evaluation of crystals in formalin-fixed, paraffin-embedded tissue sections for the differential diagnosis of pseudogout, gout, and tumoral calcinosis.". Mod Pathol 14 (8): 806-10. doi:10.1038/modpathol.3880394. PMID 11504841.
  4. ↑ Saukko, Pekka; Knight, Bernard (2004). Knight's Forensic Pathology (3rd ed.). A Hodder Arnold Publication. pp. 589. ISBN 978-0340760444.
  5. ↑ URL: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/. Accessed on: 28 October 2011.

External links

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