giant cell tumor (GCT): subchondral cysts of CPPD can be large and simulate subchondral GCT.osteoarthritis: usually have the typical weight-bearing distribution.Possible imaging differential considerations include CPPD disease can be differentiated from gout on ultrasound given that echogenic monosodium urate crystals line the surface of articular cartilage, whereas echogenic CPPD calcifications are located within the cartilage itself 7.ĬPPD in the knee is associated with scalloping of the anterior femoral cortex at the level of the patella 13. It is controversial whether gout leads to calcification of articular fibrocartilage or hyaline cartilage 6. crowned dens syndrome: acute pain and systemic inflammatory syndrome 5.wrist: triangular fibrocartilage complex and lunotriquetral ligaments.
knee: medial meniscus and patellofemoral joint.a stepladder pattern of joint narrowing is classically described in which the narrowing is progressively less severe from the radiocarpal joint to the midcarpal jointĬhondrocalcinosis can occur in many locations.SLAC wrist can be seen in advanced cases.wrist joint (mainly radiocarpal and scapholunate joints).AD pattern mutation in the ANKH gene which encodes a transmembrane inorganic pyrophosphate transporterĬPPD has many features of osteoarthritis with an unusual distribution, for example, they tend to be symmetric in distribution and involve non-weight bearing joints or, in the hands, mainly involve the intercarpal and metacarpophalangeal joints.įeatures of osteoarthritis in joints that are not commonly affected by it (i.e.The crystals are weakly positively birefringent on polarized microscopy and have a rhomboid or rod shape. Another common joint is the pubic symphysis.Ĭhronic CPPD crystal inflammatory arthritis presents with chronic, intermittent painful swelling in the peripheral joints of upper and lower extremities. Unlike gout, it most commonly involves the knee and the upper joints (shoulder, elbow, wrist). The presentation classically resembles an acute gout attack. Most patients with imaging findings of CPPD are clinically asymptomatic.Īcute CPPD crystal arthritis ( pseudogout) presents with severe acute or subacute pain, swelling, erythema, and warmth, of one or more joints and is usually self-limited. EpidemiologyĬPPD is commonest in patients over the age of 50. NB: in CPPD, the D stands for deposition not disease nor dihydrate, so it is "CPPD disease" 9. chronic CPPD crystal inflammatory arthritis.osteoarthritis with CPPD: typical changes of osteoarthritis in the setting of CPPD.acute CPPD crystal arthritis (formerly pseudogout): self-limiting synovitis in the setting of CPPD.asymptomatic CPPD: chondrocalcinosis +/- changes of osteoarthritis, but clinically asymptomatic.CPPD: occurrence of calcium pyrophosphate crystals, with or without symptoms.In response, in 2011 the European League Against Rheumatism (EULAR) proposed a standardized terminology corresponding to clinical presentation 9: Indeed, although initially described as chondrocalcinosis articularis, it is now understood that imaging findings of chondrocalcinosis do not always indicate CPPD disease 9. This article reviews the protean manifestations of CPPD crystal deposition disease with emphasis on diagnostic imaging.The terminology regarding CPPD disease has been confusing, with chondrocalcinosis, CPPD, and pseudogout often used synonymously. Pyrophosphate arthropathy is a term that has been used to describe the peculiar pattern of joint destruction associated with CPPD crystal deposition disease. Pseudogout is just one of the multiple clinical presentations for CPPD crystal deposition disease. Pseudogout is a clinical term applied to an acute inflammatory process in a joint(s) mimicking a gout attack. Chondrocalcinosis is a pathologic and radiographic term denoting calcification of cartilage within joints including both hyaline articular cartilage and fibrocartilage. CPPD crystal deposition disease is among many conditions that may result in crystal deposition within cartilage. Various terms have been utilized to describe this arthropathy, which has led to some confusion. Buy Article Permissions and Reprints ABSTRACTĬalcium pyrophosphate dihydrate (CPPD) crystal deposition disease is characterized by the accumulation of pyrophosphate dihydrate crystals in articular and periarticular tissues.
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