Age / Sex : 74 / F

Chief complaint: painful swelling of 3rd & 4th finger (onset: 3 days ago)

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)

Acute calcific periarthritis

Discussion

Discussion:

•       Acute periarticular inflammation with juxtaarticular deposits of calcium hydroxyapatite or other basic calcium phosphate crystals

•       Degeneration  of   the  fibrous  tissue,  likely  related  to  microtrauma,  and  subsequent  intratendinous  necrosis

•       Mostly unifocal and self-limited

•       Sites

–      Most commonly tendons about the shoulder

–      Followed by hip and knee

•       Conservative treatment

•       Clinical history and radiographic appearance are enough

•       Plain radiograph

–      Calcification localized to the symptomatic site: almost pathognomonic with appropriate clinical history

–      Calcification size can be variable and does not correlate with the severity of symptoms

–      Calcification becomes less well-defined and may fragment before disappearing entirely within weeks to months

•       MRI

–      Calcified lesions shows variable signal intensity on T2-weighted images depending on the amount of lipid contents

References:

1. Periarticular Calcifications in Two Patients With Acute Hand Pain. Emily N. Vinson¹, Shivang V. Desai, Suraj Reddy. AJR 2010;195: S76-S79.
2.  Acute calcific periarthritis of the hand and wrist: a series and review of the literature Doumas C, Vazirani RM, Clifford PD, Owens P.Emerg Radiol. 2007 Sep;14(4):199-203.