101/186. Crystallographic identification of a calcium deposit in calcified pericarditis associated with articular chondrocalcinosis. In a case of CPPD crystal deposition disease of the pseudorheumatoid type and of long duration, calcified constrictive pericarditis developed and was surgically treated. Analysis of the calcium deposit in the pericardium was carefully made by infrared absorption, x-ray diffraction, and thermogravimetry. It revealed that the deposit was composed of B-type carbonated apatite. Previously, both calcium pyrophosphate dihydrate (CPPD) and apatite crystals, either in the same place or in different tissues, have been reported in the same patient. These observations raise the possibility that the same metabolic error might lead to both types of crystal deposition. ( info) |
102/186. Cervical myelopathy attributable to pseudogout. Case report with radiologic, histologic, and crystallographic observations. A 77-year-old woman complained of numbness in her hands and feet, progressive unsteadiness, weakness, and loss of proprioception of six months' duration. A myelogram revealed stenosis of the spinal canal at the levels of C2-3, T6-7, L2-3, and L3-4. On computerized tomography scan, a large dorsal, epidural, soft tissue mass and focal calcification of the ligamentum flavum were seen at C3. Laboratory studies ruled out gout, collagen disease, vitamin B12 deficiency, syphilis, parathyroid, and thyroid disease. At decompressive laminectomy, a nodular mass in the ligamentum flavum (C2-4) was found and removed. Three months after operation, the neurologic symptoms had improved. Histologic examination of the elastic ligament revealed deposits of birefringent crystals, which were identified by x-ray diffraction as calcium pyrophosphate dihydrate (CCPD). Only about six cases of myelopathy attributable to deposits of CPPD appear to have been previously reported. ( info) |
| Three cases of acute pseudogout of the temporomandibular joint are described. The rarity of pseudogout in this joint may be partly due to a failure to recognize this diagnosis as a cause of facial pain. ( info) |
| chondrocalcinosis, ie, calcium pyrophosphate dehydrate (CPPD) crystal deposition disease, has a spectrum of clinical manifestations ranging from an absence of symptoms to a severely destructive arthropathy. We recently treated a patient with CPPD deposition adjacent to the temporomandibular joint, which simulated a parotid tumor. The CPPD crystals are weakly positively birefringent under a polarizing microscope. Most frequently they are found roentgenographically as asymptomatic deposits in fibrocartilaginous structures, especially the knee meniscus. A less frequent manifestation is "pseudogout" acute arthritis. Rarely, joint destruction is found. ( info) |
105/186. Multiple microcrystal deposition within a family. A family is described in which four members in three generations showed evidence of crystal deposition disease: two developed calcium pyrophosphate dihydrate (CPPD) crystal deposition, one calcific periarthritis, and one mixed crystal deposition disease (gout chondrocalcinosis). This previously undescribed observation supports a possible role for nonspecific heritable connective tissue factors in predisposing to crystal deposition. ( info) |
106/186. Pseudogout of the wrist presenting as acute median nerve compression. Two cases are reported of acute median nerve compression due to calcium pyrophosphate deposition in the wrist, masquerading as a septic condition. There have been recent reports in the literature of the effects of calcium pyrophosphate in joints of the upper limb (Resnick 1983 and Hensley, 1983) These conditions are uncommon and the presentation and initial symptomatology of our case led in the first patient to misdiagnosis and an unnecessary operation, which was avoided in the second case. ( info) |
107/186. Acute pseudogout in chronic renal failure. Acute pseudogout (calcium pyrophosphate dihydrate deposition disease [CPPD disease]) developed in two patients with chronic renal failure. The disease had atypical features. The calcification of the involved joints was more diffuse than the usual linear stippled calcification. The first patient, age 39, was young to have pseudogout. The second patient had pseudogout and chondrocalcinosis limited to the elbow. review of wrist roentgenograms of 82 patients (mean age, 49.0 years), undergoing hemodialysis for chronic renal failure revealed three patients (a 3.7% incidence) with chondrocalcinosis. The incidence increased to three of 19 (15.8%) in the patients over the age of 60. Although considered uncommon, pseudogout may cause acute arthritis in chronic renal failure more often than previously suspected. Joint aspiration and identification of CPPD cystals with compensated polarized light microscopy will establish the diagnosis of pseudogout. ( info) |
108/186. Erosive intervertebral osteochondrosis in association with generalized osteoarthritis and chondroc alcinosis; anatomico-radiological study of a case. This paper concerns a radiological and postmortem study of an 81-year-old woman with diffuse intervertebral osteochondrosis (T12-L1 severe erosion) in association with generalized osteoarthritis and articular chondrocalcinosis. Varying degrees of cartilage plate flaws with cartilaginous Schmorl's nodes and vertebral plateaux erosion are shown to occur without calcium pyrophosphate crystal deposits in situ. Differential diagnosis between intervertebral osteochondrosis and infectious spondylitis may require a combination of tomographic evolution over time, bone scans and biopsy, the latter being not always conclusive. ( info) |
109/186. Cervical radiculomyelopathy caused by deposition of calcium pyrophosphate dihydrate crystals in the ligamenta flava. Case report. A case of cervical radiculomyelopathy caused by multiple calcified nodules in the ligamenta flava is presented. Roentgenological examination of the cervical spine showed radiopaque nodular lesions, 7 x 7 x 5 mm in size, located in the paramedian portion of the posterior spinal canal. The nodules were removed surgically and they were confirmed to be calcifications of ligamenta flava. Microscopic examination of the nodules with the polarized light revealed extensive deposition of crystals. By x-ray diffraction study, the crystal was determined as calcium pyrophosphate dihydrate (CPPD: Ca2P2O7 . 2H2O). Although CPPD deposition in the cartilage has been known as pseudo-gout syndrome, deposition in the ligament has been reported only in a few cases. This is the first case with radiopaque calcified nodules in the ligamenta flava causing spinal cord compression, the composition of which proved to be CPPD. ( info) |
110/186. Ultra-microcrystals in pyrophosphate arthropathy. Crystal identification and case report. A patient with pyrophosphate arthropathy is reported who had no calcifications on joint radiographs, and no crystals were found in polarized light microscopy of the synovial fluid. Using techniques for idenfication of crystals at the ultrastructural level, abundant small (less than or equal to 1 mu) pyrophosphate crystals were recognized and identified. The possibility of "ultramicrocrystal depositions", including pyrophosphate arthropathy, is important to consider in acute arthritides since small crystals might cause more intense inflammation and be the cause of arthritides, hitherto not possible to classify. ( info) |