The prevalence of chondrocalcinosis (CC) of the acromioclavicular (AC) joint on chest radiographs and correlation with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease

Abstract

Digital imaging combined with picture archiving and communication system (PACS) access allows detailed image retrieval and magnification. Calcium pyrophosphate dihydrate (CPPD) crystals preferentially deposit in fibrocartilages, the cartilage of the acromioclavicular (AC) joint being one such structure. We sought to determine if examination of the AC joints on magnified PACS imaging of chest films would be useful in identifying chondrocalcinosis (CC). Retrospective radiographic readings and chart reviews involving 1,920 patients aged 50 or more who had routine outpatient chest radiographs over a 4-month period were performed. Knee radiographs were available for comparison in 489 patients. Medical records were reviewed to abstract demographics, chest film reports, and diagnoses. AC joint CC was identified in 1.1 % (21/1,920) of consecutive chest films. Patients with AC joint CC were 75 years of age versus 65.4 in those without CC (p<0.0002). Four hundred eighty-nine patients had knee films. Six of these patients had AC joint CC, and of these, five also had knee CC (83 %). Of the 483 without AC joint CC, 62 (12 %) had knee CC (p=0.002). Patients with AC joint CC were more likely to have a recorded history of CPPD crystal deposition disease than those without AC joint CC (14 versus 1 %, p=0.0017). The prevalence of AC joint CC increases with age and is associated with knee CC. A finding of AC joint CC should heighten suspicion of pseudogout or secondary osteoarthritis in appropriate clinical settings and, in a young patient, should alert the clinician to the possibility of an associated metabolic condition.

The Incidence and Significance of Calcium Pyrophosphate Dihydrate Deposits in Histologic Examinations of Total Hip, Knee, and Shoulder Joint Arthroplasties

“…23 In terms of sites affected by CPPD, numerous reports have established that knees are by far the most commonly affected joint, followed by the wrists, hips, symphysis pubis, metacarpophalangeal, and acromioclavicular joints. 10,[22][23][24][25][26] In our series, all CPPD cases but one were analyzed solely by plain films. However, among the entire 169 arthroplasty cases with CPPD detected pathologically, only 35 (21%) were documented in the preoperative radiology report.…”

Lumbar Extradural Pseudogout Mass Manifesting as Radiculopathy: A Case Report

“…Patients with AC joint chondrocalcinosis are more likely to have a history of CPPD crystals than patients without AC joint chondrocalcinosis. 12 Christie M. Bartels even proposed the use of A/B/C categories to establish diagnostic criteria for CPPD disease. 13 …”

Acromioclavicular Joint Disease

“…There is a positive relationship between chondrocalcinosis and CPPD, suggesting that the presence of ACJ chondrocalcinosis in younger individuals should prompt consideration of underlying metabolic conditions such as hemochromatosis and hyperparathyroidism. 26 Hemochromatosis causes arthropathy in up to 50 to 80% of patients, and not infrequently it involves the joints of the shoulder girdle. 27 Hemochromatosis may be radiographically indistinguishable from CPPD or osteoarthrosis, and in this instance MRI is the most sensitive and specific investigation because it permits identification of paramagnetic articular material consistent with iron deposition.…”