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Ananya Chakravorty, Ronald T. Murambi, and Ravi Kumar V. Cherukuri

C alcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout, is a crystalline arthropathy generally affecting large joints and periarticular tissue. 1 It rarely affects the spine and tends to be limited to extradural articular, ligamentous, and soft-tissue structures when it does. Only one case of intradural CPPD disease has been reported in the literature. We present the second reported case of intradural CPPD disease masquerading as an intradural extramedullary spinal tumor. Case Report An 81-year-old man

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Kelly J. Bridges, Carli L. Bullis, Ajay Wanchu, and Khoi D. Than

P seudogout is a widely recognized form of acute calcium pyrophosphate deposition (CPPD) disease, presenting as acute arthritis of monoarticular or oligoarticular joints. 25 CPPD affects 4%–7% of adults in the United States. 2 , 25 The disease typically afflicts people older than 60 years, with increasing incidence with age. 27 Common signs include erythema, warmth, and swelling of the affected joint, with a clinical presentation similar to gout or septic arthritis. 23 Patients often present with fevers, chills, and constitutional symptoms lasting weeks to

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Nobuyuki Kawano, Sanae Yoshida, Takashi Ohwada, Kenzoh Yada, Kenichi Sasaki, and Takashi Matsuno

S ince the detailed descriptions by Žitňan and Sit'aj, 10 and by McCarty, et al. , 5, 6 the clinical syndrome associated with calcification of the articular cartilage has received increased attention in the past several years. Žitňan and Sit'aj 10 described the entity as “articular chondrocalcinosis” from their roentgenological observations. At about the same time, McCarty, et al. , 5, 6 analyzed deposited crystals from the inflamed joint and confirmed them to be calcium pyrophosphate dihydrate (CPPD). They preferred the term “pseudo-gout syndrome

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Sergio Paolini, Pasquale Ciappetta, Antonio Guiducci, Massimo Principi, Paolo Missori, and Roberto Delfini

C alcium pyrophosphate dihydrate crystal deposition may cause a well-recognized systemic arthropathy also known as pseudogout. 6, 20 It may develop either as a primary arthropathy or in association with endocrine or metabolic diseases. Although uncommon, spinal deposition of CPPD is increasingly reported as a cause of myeloradiculopathy. 1, 8, 13, 21, 23 The most commonly affected sites are the cervical and the lumbar spine, whereas the thoracic location is rare. 11 In the previously reported cases, the calcification typically involved the posterior aspect

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Chikao Nagashima, Motohide Takahama, Toshikatsu Shibata, Hiroaki Nakamura, Keiichi Okada, Hitoshi Morita, and Hirokazu Kubo

I n 1962, McCarty and co-workers 15, 20 first discovered microcrystals of calcium pyrophosphate dihydrate (CPPD) in the leukocytes of fluid from inflamed joints of patients with painful arthropathy. It was called “articular chondrocalcinosis” by Žitňan and Sit'aj. 32 Since then, there have been several reports of “CPPD deposit disease” with characteristic articular linear radiodensities 28 with or without associated diseases such as diabetes mellitus, hyperparathyroidism, classical gout, osteoarthritis, hemochromatosis, chronic renal disease, and

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Nobuyuki Kawano, Takashi Matsuno, Shichiro Miyazawa, Hideo Iida, Kenzoh Yada, Nobumitsu Kobayashi, and Yoshinobu Iwasaki

crystal with x-ray microanalysis indicated that the Ca:P ratio was 1 in the plate-shaped crystals and Ca:P = 1.5 to 1.8 in the microspheroids. The former showed a similar basic composition to calcium pyrophosphate dihydrate (CPPD), the latter to hydroxyapatite. Fig. 3. Scanning electron micrograph of the outer layer of the nodular calcification showing ligamentum flavum at the left of the picture. The crystals, which are plate-shaped and 0.5 to 1.5 µ long, are tightly packed. Undecalcified specimen: section treated with gold, × 28,000. Fig. 4

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Bernhard Zünkeler, Robert Schelper, and Arnold H. Menezes

reported to cause anterior cervicomedullary compression is calcium pyrophosphate dihydrate (CPPD) deposition, which leads to large inflammatory masses surrounding the odontoid process. An exhaustive search of the literature revealed four such cases in elderly women. 2, 5, 9, 25 The first reported case (Case 1 in Table 1 ) was that of a 76-year-old quadriparetic woman with a large retroodontoid mass, who was evaluated and treated by the senior author (A.H.M.) at this institution. 5, 15 Subsequently, three similar cases, those of an 84-year-old woman, 2 an 85-year

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Gerald A. Grant, Mark H. Wener, Hadi Yaziji, Neal Futran, Mary P. Bronner, Neil Mandel, and Marc R. Mayberg

T he crystal deposits responsible for disease in articular and soft tissues include sodium urate, which is responsible for classic gout and gouty tophi; calcium pyrophosphate dihydrate (CPPD), which commonly causes pseudogout and chondrocalcinosis; and calcium hydroxyapatite, which is responsible for most cases of calcific tendonitis and joint capsule calcium deposits. Dense, widespread soft-tissue calcium-containing deposits are termed “tumoral calcinosis” and are usually composed of calcium hydroxapatite. 1 Rarely, tumoral calcinosis has been described to be

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Albert J. Fenoy, Arnold H. Menezes, Kathleen A. Donovan, and Stephen F. Kralik

osteoclastoma. 9 , 14 , 18 , 22 , 23 , 25 A more rare condition is CPPD deposition, which leads to the formation of large inflammatory masses surrounding the odontoid process. Calcium pyrophosphate dihydrate crystals are deposited exclusively in joints and bursae, and occasionally disrupt the anatomical confines of the joint to form large masses that may be confused with tumors in the periarticular tissues. 21 Histologically, the disease is characterized by the deposition of weakly birefringent rhomboid crystals 12 visible on light microscopy at medium and high

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Vincent Baty, Bénédicte Prost, Anne Jouvet, Jacques Laurent, and Bernard Vallée

The clinical manifestations of calcium pyrophosphate dihydrate (CPPD) deposition disease, which usually occur in elderly patients, range from incidental findings to a destructive arthropathy. Few cases of cord compression related to CPPD deposits have been reported; in most chronic and progressive symptoms have been the result of calcifications of the ligamentum flavum and the periodontoid joint tissues. 1, 2, 5 We report on the unusual case of an acute herniated disc syndrome in which lumbar cord compression was secondary to CPPD deposits in a young woman