Bob Lopez just answered my question, he wrote:
I think it’s mostly gout.
I also think that I recollect that there can be mixed crystals disease in a large number of cases ( ie uric acid and calcium pyrophosphate crystals in same synovial fluid)
One thing that I have been told in the ultrasound rheum literature they make a point of uric acid coating the cartilage surface vs CPPD more deep within the cartilage and that sag CT looks more like surface?
The chondrocalcinosis is at the surface, not within the substance of the hyaline cartilage…That makes more sense.
Been seeing an epidemic of gout in young men in their 30s….just saying…what’s that about?
Hilary
Nodular mass in popliteus sheath eroding LFC with reactive marrow edema and joint effusion…reported by colleague as possible gout vs pvns
Oct 23
CT from today reveals multifocal soft tissue calcifications in the popliteus tendon sheath, the ACL and coronary ligament
Arrow points to what looks like hyaline cartilage chondrocalcinosis
So….at this point I’m wondering if this is Gout or CPPD (pseudogout)Then I found other foot and ankle MRI from 2 months ago
Tumor like expansion / destruction of the fibular sesamoid
Today’s CT was ordered as DECT, which we don’t have
It seems the additional foot findings favor gout….but based on the conventional CT alone, can we know?
I thought that hyaline cartilage calcification favors CPPD.
Then again, I think he’s way too young for pseudogout.So my questions are:
Is there any utility of conventional CT to differentiate gout from CPPD?
Is this case so clearly gout that there is No point in pursuing DECT?Thanks
Hilary
