Ultrasound case of the month nov 13


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MSK ultrasound, knee chondrocalcinosis, knee ultrasound

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Ultrasound case of the month nov 13

  1. 1. Ultrasound Case of the Month November 2013
  2. 2. 81 year old woman with chronic left knee pain
  3. 3. Grayscale Images of the Left Knee Trans image at the trochlea (knee flexed) Trans image at the far lateral aspect of the femorotibial joint
  4. 4. Grayscale Images of the Left Knee There are thin, hyperechoic linear foci within the hyaline cartilage of the trochlea and lateral femorotibial compartment
  5. 5. Diagnosis: Chondrocalcinosis
  6. 6. Chondrocalcinosis • Multiple causes, the most common due to calcium pyrophosphate deposition disease (CPPD) • Others include: • • • • Gout Wilson disease Hemochromatosis Ochranosis • • • • Hypophosphatasia Hyperaparathyroidism Hypomagnesemia Hypothyroidism
  7. 7. Ultrasound of the Normal Knee • Hyaline cartilage is normally homogeneously hypoechoic • Trochlear and anterior surfaces of the femoral condyles are best seen with the knee flexed Trochlear cartilage
  8. 8. Ultrasound of the Normal Knee • Sharp anterior and posterior interfaces • Ultrasound is limited in evaluating the far inner margins of both the lateral and medial femorotibial joints Far lateral aspect of the lateral femoral condyle
  9. 9. Ultrasound of the Knee with Chondrocalcinosis • Calcifications are within the hyaline cartilage • Parallel to the femoral condyle
  10. 10. Ultrasound of the Knee with Chondrocalcinosis • Acoustic shadowing typical of calcifications on ultrasound are not seen because these calcifications are small and do not function as a barrier to sound penetration
  11. 11. Ultrasound of the Knee with Chondrocalcinosis • In our case, the patient had radiographs performed seven years prior, which also demonstrated chondrocalcinosis • This heterogeneous calcification corresponds to meniscal (fibrocartilage) calcification seen on the ultrasound
  12. 12. Ultrasound of the Knee with Chondrocalcinosis Fem condyle Tibial plateau The lateral meniscus is extruded into the lateral joint space in this patient secondary to meniscal tear
  13. 13. Further Reading… Foldes K. Knee chondrocalcinosis: An ultrasonographic study of hyalin cartilage. J of Clin Im. 2002; 26:194-196 Kaushik S, et al. Effect of Chondrocalcinosis on the MR Imaging of Knee Menisci. AJR. 2001; 177:905909. Sofka CM, Adler RS, Cordasco FA. Ultrasound diagnosis of chondrocalcinosis in the knee. Skel Rad. 2002; 31:43-45
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