ABSTRACT
BACKGROUND: Calcium pyrophosphate dihydrate deposition disease (CPDD) is a rare disease in the temporomandibular joint (TMJ) space. It forms a calcified crystal mass and induces a limitation of joint movement. CASE PRESENTATION: The calcified mass in our case was occupied in the left TMJ area and extended to the infratemporal and middle cranial fossa. For a complete excision of this mass, we performed a vertical ramus osteotomy and resected the mass around the mandibular condyle. The calcified mass in the infratemporal fossa was carefully excised, and the segmented mandible was anatomically repositioned. Scanning electronic microscopy (SEM)/energy-dispersive X-ray spectroscopy (EDS) microanalysis was performed to evaluate the calcified mass. The result of SEM/EDS showed that the crystal mass was completely composed of calcium pyrophosphate dihydrate. This result strongly suggested that the calcified mass was CPDD in the TMJ area. CONCLUSIONS: CPDD in the TMJ is a rare disease and is difficult to differentially diagnose from other neoplasms. A histological examination and quantitative microanalysis are required to confirm the diagnosis. In our patient, CPDD in the TMJ was successfully removed via the extracorporeal approach. SEM/EDS microanalysis was used for the differential diagnosis.
Subject(s)
Humans , Calcium Pyrophosphate , Calcium , Chondrocalcinosis , Cranial Fossa, Middle , Diagnosis , Diagnosis, Differential , Joints , Mandible , Mandibular Condyle , Microscopy , Osteotomy , Rare Diseases , Spectrum Analysis , Temporomandibular JointABSTRACT
The latest recommendations for the diagnosis and management of crystal-induced arthritis, such as gout and calcium pyrophosphate dihydrate (CPPD) deposition disease, recognize the diagnostic potential of musculoskeletal ultrasonography (MSUS). MSUS allows rapid, highly sensitive, non-invasive detection of microcrystal aggregates in multiple anatomic areas, and can be used as a safe, reliable guide for aspiration of articular and periarticular specimens suitable for microscopic analysis. MSUS can also be used to monitor disease after treatment. Ultrasonographic differentiation between gout and CPPD deposition disease is based on the characteristics of crystal aggregates and their preferential localization in different anatomical areas. This rapid assessment may profoundly affect the clinical process, avoiding expensive, time-consuming diagnostic procedures. This article reviews the current status of and recent advances in MSUS imaging in crystal-induced arthritis.
Subject(s)
Arthritis , Calcium Pyrophosphate , Chondrocalcinosis , Diagnosis , Gout , UltrasonographyABSTRACT
Calcium pyrophosphate dihydrate (CPPD) deposition disease is a heterogeneous group of diseases with CPPD crystal deposition. Aging is the most common risk factor for CPPD deposition, followed by osteoarthritis and previous injury. Occasionally, CPPD depositions are associated with familial predisposition and metabolic diseases, including hemochromatosis, primary hyperparathyroidism, hypophosphatasia, and hypomagnesemia. CPPD deposition diseases associated with primary hyperparathyroidism in Koreans have rarely been reported. Thus, we report a case of a relatively young female patient with CPPD deposition disease associated with primary hyperparathyroidism, which was diagnosed through a polarized microscopic examination of the synovial fluid and a subtotal parathyroidectomy.
Subject(s)
Female , Humans , Aging , Calcium Pyrophosphate , Chondrocalcinosis , Hemochromatosis , Hyperparathyroidism, Primary , Hypophosphatasia , Metabolic Diseases , Osteoarthritis , Parathyroidectomy , Risk Factors , Synovial FluidABSTRACT
We report a case of calcium pyrophosphate dihydrate crystal deposition disease (CPDD) presenting as an acute polyarthritis. A 66-yr-old woman was admitted with a 5-day history of fever and multiple joint pain including wrists, elbows, shoul-ders, knees, and ankles developed 5 days before admission. Her plain radiographs of wrists, elbows, shoulders, knees, and ankles showed chondrocalcinosis. The pubic symphysis, lumbar intervertebral discs, and both hip joints, which were asymptomatic, also had calcium deposits. The compensated polarized microscopic examination of the joint fluid, aspirated from the right knee revealed intracellular and extracellular weakly positive birefringent crystals, confirming the CPDD. This case showed that CPDD may manifest as an acute polyarthritis mimicking acute onset rheumatoid arthritis.