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Segond fracture
0%
0/34
Osteophytes
3%
1/34
Joint space narrowing
Lipohemarthrosis
Chondrocalcinosis
91%
31/34
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This patient's presentation is consistent with a diagnosis of pseudogout or Calcium Pyrophosphate Deposition Disease (CPDD). Pseudogout is associated with chondrocalcinosis, or calcification of adjacent cartilagenous structures in the knee joint, seen on radiography. CPDD has a very similar clinical presentation to gout; however, pseudogout typically affects older patients and more proximal joints (the knee is the joint most frequently affected). Additionally, psuedogout is characterized by positively birefringent rhomboid-shaped crystals. Chondrocalcinosis refers to radiographic evidence of calcification in hyaline or fibrous cartilage. On knee radiograph, a dense line within the hyaline cartilage parallels the articular surface. Siva et al. discuss the diagnostic approach of acute monoarticular arthritis in adults. Crystal deposition, infection, and trauma are the most common causes. Evaluation of joint fluid with polarized microscopy is often helpful; however, leukocyte counts are typically unreliable and nonspecific. Magarelli et al. review the imaging findings in pseudogout. CPDD is characterized by accumulation of crystals in the articular and periarticular tissues. CT, ultrasound, and MRI all have demonstrated utility in detecting crystal deposits in joints. Illustration A depicts an AP radiograph of a knee demonstrating chondrocalcinosis; note the radiodense lines paralleling the articular surface and calcification of the menisci. Illustration B is an image summarizing the radiographic findings seen in CPDD. Illustration C shows the rhomboid-shaped crystal of pseudogout. Incorrect Answers: Answer 1: A Segond fracture is a small avulsion fracture of the lateral tibial condyle just below the joint line that is a recognized sign of ACL injury. Answers 2 & 3: These are findings seen in osteoarthritis of the knee and are not expected in this patient, who lacks a history of prior knee pathology. Answer 4: Lipohemarthrosis, the presence of blood and fat in the joint, that can be indicative of a fracture that communicates with the knee joint.
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