case m/23 c.c. : 1 st mtp joint pain (1ya). 20070210 foot ap/ sesamoid
DESCRIPTION
Outside CT (Rt. Foot)TRANSCRIPT
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Case
• M/23• C.C. : 1st MTP joint pain (1YA)
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20070210 Foot AP/ sesamoid
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20061202 Outside CT (Rt. Foot)
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Radiologic findings-CT• Expansile osteolytic mass at medial sesamoid
of hallux - with suspicious fracture lines -> DDx) 1. chondroblastoma or GCT 2. ABC 3. intraosseous gout
• Rec) Rt foot MRI using microcoil
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20070220 Foot MRI (Rt.)_Contrast
T1 sagittal
T1 sagittal (FS/Gd+)
T1 coronal
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20070220 Foot MRI (Rt.)_Contrast
T1 axial T2 axial
T1 axial (FS/Gd+)
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Radiologic findings-MRI• Expansile mass involving medial sesamoid of hallux
- peripheral irregular thick enhancement and central nonenhancing cystic or necrotic area
- with its associated synovial enhancement of lst MTP joint- with bony erosion at lst metatarsal neck c reactive bone marrow
edema- vascular structures anterior to the mass- closely abutting flexor hallucis tendon
->DDx) 1. intraosseous gout,most likely 2. tbc 3. tumorous condition such as giant cell tumor or chondroblastoma
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Hospital course• Op: Excision of Sesamoid, Rt.(2007-02-26)
• Pathologic diagnosis– Soft tissue, right foot, excision
• 1. Numerous rhomboid crystals showing birefringence• 2. Some foci of calcium deposit • 3. Chronic granulomatous inflammation
with 1) multinucleated giant cells 2) central hyaline degeneration
consistent with calcium pyrophosphate dihydrate deposition disease
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Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease
• Etiology– Idiopathic: most common
• Increased with age (7% of population near age 70 and 30-60% by the age 80)– Hereditary: autosomal dominant condition
• Maybe associated with ANK(chromosome 5p15)– Secondary: 5-10% of patients have metabolic disease.
• Hyperparathyroidism, Hemochromatosis, Hypophosphatasia…
• Clinical patterns– Asymptomatic chondrocalcinosis– CPPD crystal arthropathy
• Pseudogout (18%), pseudo-osteoarthritis with/without synovitis (40%/18%), pseudorheumatoid arthritis (8%)
• Common location: Knee, wrist, MCP joint
Seminars in musculoskeletal radiology 2003;07:175-186
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Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease
• Diagnositic imagings– Conventional radiography
• Calcification within or around joints– Chondrocalcinosis – Synovial and capsular calcifications– Other soft tissue calcification
• Findings of pyrophosphate arthropathy– Bilateral, symmetrical involvement of affected articulations– Cartilage loss, subchondral plate sclerosis, subchondral cyst formation– Subchondral collpase, fragmentation, intra-articular loose body
– MRI• Less dense calcium deposition->GRE sequence is more sensitive than c
onventional radiography.
Seminars in musculoskeletal radiology 2003;07:175-186
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Seminars in musculoskeletal radiology 2003;07:175-186