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