IMAGE OF INTEREST : Detection of calcium pyrophosphate dihydrate crystal deposition disease by dual-energy computed tomography

• Published in: The Korean journal of internal medicine Vol. 29; no. 3; pp. 404 - 405
• Main Authors: Hae Rim Kim, Jung Hwa Lee, Na Ra Kim, Sang Heon Lee
• Format: Journal Article
• Language: Korean
• Published: 대한내과학회 30.05.2014
• ISSN: 1226-3303; 2005-6648

A 52-year-old woman presented withpainful swelling in both knees for 7days. Physical examination identifiedmarked swelling and tenderness inboth knee joints that she reported tohave recurred for the past 6 years. Laboratorytests determined the erythrocytesedimentation rate to be 107 mm/hr, C-reactive protein as 25.55 mg/dL,and serum uric acid levels as 4.1 mg/dL. Calcium pyrophosphate dihydrate(CPPD) crystals were found on polarizedlight microscopy examination ofknee joint synovial f luid. Culturesidentified no microorganisms. Plainradiography of the right knee revealedmultiple calcifications in the medialand lateral menisci and the femoralcondylar cartilage (Fig. 1). Dual-energycomputed tomography (DECT), whichdifferentiates monosodium urate (color-coded in green) from calcium (color-coded in blue), revealed multiplecalcium depositions in the anteriorand posterior cruciate ligaments, aswell as in both menisci and the femoralcondylar cartilage (Fig. 2). The patientwas diagnosed as having CPPDcrystal deposition disease of both kneejoints. Intra-articular injection of triamcinoloneeffectively relieved herpain.