Weekly Case

Title : Case 606

Age / Sex : 38 / F

Chief complaint : Palpable lesion in the lower back with pain

What is your impression?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : 
Eugene Lee, Seoul National University Bundang Hospital



Answer: hydroxyapatite crystal deposition disease (with acute inflammation) at supraspinous ligament of L2-3 level



  • Initial plain radiograph : focal calcification at posterior aspect of spinous process (L2) inferior margin


  • MRI : T1 and T2 low signal intensity foci at supraspinous ligament of L2-3 level with adjacent soft tissue inflammatory enhancement


  • Follow-up plain radiograph : nearly resolved previous calcification at supraspinous ligament of L2-3 level on 2 months follow-up


Differential Diagnosis: none



 HADD (Hydroxyapatite crystal deposition disease)

  • HADD in the spine is found in three typical locations : (1) within the longus colli muscle, (2) surrounding the dens, and (3) within the intervertebral discs, the anterosuperior portion of the longus colli muscle is most commonly involved

  • The ligaments and apophyseal joints may also be calcified.

  • Paraspinal HADD masses can narrow the spinal canal, causing a symptomatic radiculopathy or neuropathy.

  • Paraspinal HADD may also be symptomatic due to the inflammatory response elicited by crystals.

  • MRI : HADD in tendons/ligaments has low signal on T1 and T2WIs. Sometimes there is surrounding edema, which appears on MRI as a rim of increased signal intensity on T2WIs. Combined active inflammation can be enhanced.




  • Imaging of arthritis and Metabolic Bone disease, Elsevier Health Sciences, 2009



Correct Answer
Total applicants 31 Correct answers 15
Name Institution
김기욱 국군대전병원, 전문의
이규정 고대구로병원, 전공의
남태훈 국군서울지구병원, 전문의
박선영 한림대학교 성심병원, 전문의
김창현 전문의
강지희 서울대학교병원, 전공의
서현주 전문의
이은채 전문의
김보람 전문의
이혜란 전문의
최형인 국군의무학교, 전문의
이연옥 선한목자병원, 전문의
박준동 뿌리병원, 전문의
현혜란 이대목동병원, 전문의
이소정 단국대학교병원, 전공의