case

Hi
How do you describe this finding in the report, elderly patient and pain
(everyone feels pain on this exam) and we usually has no other information.
Only MRI.

DDX:
Crowned dens syndrome
periodontoid pseudotumor
pseudogout
RA
Others

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2 thoughts on “case”

  1. OCAD

    Thank you very much for your feedback.
    Sergio Viana sends this article of his own (attached).
    The answers below:

    Retro-Odontoid pseudotumor.WY

    ___

    Crown dens

    Cppd arthropathy is 2nd mc arthritis after OA

    AC
    __________________________________
    I would call pannus. May be a CT could help in differentials. In RA,
    simetimes there is a fibrous pannus with low signal because is old. Let’s
    see what others say.
    __________________________________

    This is likely age-related retrodental ligament thickening and/or CPPD if
    calcs seen on CT. I dont see any findings to support RA

    _________________________________

    FG: My understanding is that crowned dens syndrome should not be used
    unless there are acute inflammatory signs and symptoms.
    It is also caused by CPPD deposition but isn’t the same thing as
    retroodontoid pseudotumour which is chronic and non inflammatory.
    I think this is the latter, rather than the former.

    AC: Our rheumatologists use that term with neck pain and this finding.
    Pseudotumor is a waste basket term like nsip in chest
    Location, lesion along back of odontoid, older age, and neck pain combo
    plus minus lig calcification -they use for the diagnosis.

    FG:With all due respect to your colleagues, this is not the usual use of
    the term.
    Crowned dens is uncommon and has an pronounced acute inflammatory
    presentation.
    This is super common and neck pain is vague and generally degenerative.
    So the key here is the clinical context. 🙂

    Em dom., 7 de mar. de 2021 às 10:37, Ciro Duarte <cirombd@gmail.com>
    escreveu:

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