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Pseudogout and Chondrocalcinosis

Discussion

differential diagnosis

Clinical Features

  • most often affects the knee and the wrists;

CPPD Crystal Exam

  • Crystal Examination of Synovial Fluid:
  • Calcium pyrophosphate dihydrate crystals are visualized under compensated polarized light microscopy
    • crystals may be more difficult to detect than MSU crystals because of their smaller size, more intraphagolysosomal location, & less brilliant colors;
    • in contrast to MSU crystals, CPPD crystals show weak positive birefringency and have squared or rhomboidal shaped ends;
    • aggregates do not show birefringence (or are weakly birefringent) under polarized light;
    • alizarin red stain, can confirm that these clumps are masses of calcium crystals;

Radiographic Analysis

  • punctate and linear densities in hyaline or fibrocartilage, which are found in knee menisci, acetabular labrum, & TFCC;

Calcium Pyrophosphate Deposition 1 Calcium Pyrophosphate Deposition 2

Therapeutic Principles

References