Acute neck pain in a 76 year old male
@1.110, @9.46 CT scans (axial and sagittal view) demonstrate speudo tumoral calcific deposits focused in an enlarged zygapophyseal joint without any soft tissus mass.
Cervical facet joint chondrocalcinosis
Chondrocalcinosis is a descriptive term, referring to deposition of the pyrophosphate crystal (CPPD). The idiopathic form is the most common form of the process; the prevalence of this condition increases with age . CPPD crystal deposition can be seen in several spinal structures, including intervertebral discs, joint capsules, synovium, articular cartilage, bursae, and ligaments.
CHARACTERISTIC CLINICAL FEATURES AND RADIOLOGIC FINDINGS:
Most patients with calcification of the articular cartilage and intervertebral discs are asymptomatic, althoughthese features can also be responsible for acute cervical speudogout pain. Fibrocartilaginous deposits are thick and irregular and have a shaggy, poorly defined border. CPPD deposition in joint results in erosive and destructive changes.
Differential diagnoses below can be considered:
Pyrophosphate crystals deposition are most likely to be seen in the tendons.
Rheumatoid arthritis can lead to facet joint destruction some time associated with
Scleroderma although soft-tissue calcifications are well known to occur
as a late manifestation, symptomatic paraspinal calcinosis is very rare.
Pseudogout attack of the lumbar facet joint: a case report.
Fujishiro T, Nabeshima Y, Yasui S, Fujita I, Yoshiya S, Fujii H.
Spine (Phila Pa 1976). 2002 Sep 1;27(17):E396-8.
Cervical spine and crystal-associated diseases: imaging findings.Feydy A, Lioté F, Carlier R, Chevrot A, Drapé JL. Eur Radiol. 2006 Feb;16(2):459-68.