MR features have rarely been described, except in tumoral forms, which demonstrate low signal intensity periarticular formation on T2-weighted images. CT usually demonstrates a calcified mass involving the joint space with degenerative changes of the surrounding bones (articular space narrowing, osteophytosis, subchondral cyst formation). Patients with TMJ CPDD may present with degenerative articular changes of the condyle and temporal bone. This unusual location of CPDD may be mistaken for a chondrosarcoma as extensive destruction of the temporal bone may be present.Ī variety of names have been given to massive CPDD, including “tophaceous pseudogout,” “pseudotumor,” “destructive CPDD arthropathy,” and “CPDD deposition disease.” “Pseudodegenerative” joint disease, “pseudogout,” or “pseudoneuropathic” patterns are reported ( 3). Conductive hearing loss is related to middle ear effusion, which decreases after myringotomy but rapidly reaccumulates. Some patients may be asymptomatic ( 2, 4– 16). The most frequent complaints of patients with TMJ CPDD are pain (66.6% of cases), joint swelling (50%), trismus (36.8%), abnormal occlusion (22.2%), and conductive hearing loss (22.2%). Symptoms related to joint involvement are restricted motion, morning stiffness, and contractures. Of 36 reported cases of chronic CPDD, 20 involved the TMJ ( 3). The TMJ is more commonly affected in the chronic form than in the acute form. The less frequent, chronic form is usually indistinguishable from osteoarthritis. The acute form more frequently affects the knee and is characterized by joint effusion. According to frequency of occurrence, main target sites are the knee, symphysis pubis, hand, wrist, hip, shoulder, and spine.Īcute and chronic forms are reported ( 2). Men and women older than 50 years are equally affected. Subsequently, detection of birefringent crystals in polarized light established the diagnosis of CPDD disease.ĬPDD is a metabolic disease associated with periarticular and intra-articular calcification, known as chondrocalcinosis ( 1). A CT-guided biopsy of the lesion was performed to rule out a chondrosarcoma ( Fig 3). No abnormal marrow signal intensity or enhancement was noted within the adjacent mandibular condyle. An approximately 4-cm heterogeneously enhancing mass was identified, centered in the right TMJ, displacing the mandible inferiorly and expanding the condylar fossa. Because the osseous changes were suggestive of a synovial tumor, MR imaging was performed ( Fig 2A–C). Renal function was considered within normal limits. No other joints were affected, and she had no history of other joint pain. CT showed a calcified soft tissue TMJ mass associated with osseous remodeling and widening of the articular space ( Fig 1). Hearing function rapidly improved, but the right ear remained painful with a slight increase in pain with jaw movements. Left TMJ pain was successfully treated by steroid eardrops. She was referred for acute worsening, new onset of left TMJ pain, and right-sided hearing loss. The most common targets affected by calcium deposits are joints with fibro-cartilaginous menisci (knee and wrist joints).Ī healthy 70-year-old woman presented with a 10-year history of right temporomandibular joint (TMJ) pain and an ear lump. Although gout is defined by deposits of nonrefringent crystals of uric acid, synovial fluid analysis of CPDD patients shows weakly birefringent crystals in polarized light. First described by Zitban and Sitaj in 1958 ( 1), it is a crystal deposition disease similar to gout. Imaging features of CPDD are discussed with a review of the literature.Ĭalcium pyrophosphate dihydrate deposition (CPDD), or “pseudogout,” is an uncommon disorder that primarily affects patients older than 50 years. ![]() When the diagnosis of CPDD of the TMJ is under consideration, conventional radiographs of the wrist or the knee may contribute to the final diagnosis. Diagnosis of CPDD is challenging because clinical symptoms and imaging features are not characteristic and may mimic a chondrosarcoma. Summary: Calcium pyrophosphate dihydrate deposition (CPDD) disease is a disorder that occasionally affects the temporomandibular joint (TMJ) and temporal bone, causing pain (66.6% of cases), swelling (50%), trismus (36.8%), and hearing loss (22.2%).
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