Temporal mandibular joint chondrocalcinosis (tophaceous pseudogout) diagnosed by ultrasound‐guided fine‐needle aspiration

Abstract

Tophaceous pseudogout is a calcium pyrophosphate dihydrate crystal (CPPD) deposition disease that frequently affects elderly patient in the temporomandibular joint (TMJ).A diagnosis of CPPD deposition disease in the TMJ is challenging due to its mimicking of other benign and malignant entities. Surgical exploration followed by histologic examination is by far the most frequently used diagnostic modality. We present a case of an 87-year-old female who presented with a right TMJ mass. A final diagnosis of tophaceous pseudogout was made on cellular material obtained by ultrasound-guided fine-needle aspiration (US-guided FNA). Based on our case and current available literature, ultrasound-guided FNA is a reliable tool for diagnosing tophaceous pseudogout of the TMJ. K E Y W O R D S calcium pyrophosphate dihydrate (CPPD) deposition disease, chondrocalcinosis, temporomandibular joint (TMJ), tophaceous pseudogout, ultrasound-guided fine-needle aspiration (US-guided FNA)

The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives

“…Occasionally, especially in long-term gout disease, a TMJ palpable mass may be appreciated, and US may evidence a TMJ adjacent hypoechoic mass, corresponding to the tophaceous material ( 57 , 103 ). In these cases, US can guide fine-needle aspiration for the histological confirmation of diagnosis ( 57 ).…”

Crystals and crystalloids in cytopathology: Incidence and importance

“…Identification of the crystals in synovial fluid by cytologic examination is the best way to confirm a diagnosis of CPPD disease. 35 Fluid obtained from an involved joint will often have acute inflammatory cells present in addition to the CPPD crystals. The crystals tend to be small and have rhomboid (unequal side length parallelogram) shapes (Figure 5D).…”

“…CPPD crystals form in the cartilaginous regions of the joint space. Identification of the crystals in synovial fluid by cytologic examination is the best way to confirm a diagnosis of CPPD disease 35 . Fluid obtained from an involved joint will often have acute inflammatory cells present in addition to the CPPD crystals.…”