|Title : Case 698|
Age / Sex : 58 / M
Chief complaint : left knee pain and swelling after acupuncture procedure
HADD (Hydroxy apatite deposition disease) involving lateral collateral ligament and adjacent bursa of left knee
Knee X ray: In plain radiograph, there are several cloudy amorphous calcifications at paraarticular region of lateral tibiofemoral joint. Suspicious localized osteopenia at lateral femoral epicondyle.
MRI of knee: Coronal T2 WI shows several amorphous low signal intensity lesions along the lateral collateral ligament (LCL) and the medial aspect of the LCL. In contrast enhanced coronal T1 WI, the low signal intensity lesions are again seen with peripheral enhancement and edema. The LCL also shows periligamentous enhancement. There is mild bone marrow edema at lateral epicondylar region.
CT and duel energy CT (DECT) of knee: In CT, there is faint calcific densities at the paraarticular region of lateral tibiofemoral joint, corresponding with the X ray and MRI. There is no definite green colorization representing monosodium urate crystal, at the calcific density in DECT.
Considering of the calcification morphology, location, and no green colorization in DECT make a diagnosis of HADD. After conservative treatment, he relieved symptom and the calcific densities gradually decreased their density and amount in follow-up X ray.
HADD (Hydroxy apatite deposition disease)
1) Garcia GM, McCord GC, Kumar R. Hydroxyapatite crystal deposition disease. Semin Musculoskelet Radiol. 2003 Sep;7(3):187-93.
2) Freire V, Moser TP, Lepage-Saucier M. Radiological identification and analysis of soft tissue musculoskeletal calcifications. Insights Imaging. 2018 Aug;9(4):477-492.
|Total applicants||24||Correct answers||13|
|박선영||한림대학교 성심병원, 전문의|
|Total applicants||24||Semi-Correct answers||3|