Ultrasound case of the month nov 13
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Ultrasound Case of the Month
November 2013
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81 year old woman withchronic left knee pain
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Grayscale Images of the Left Knee
Trans image at the trochlea (knee flexed)
Trans image at the far lateral aspect of the femorotibial joint
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Grayscale Images of the Left Knee
There are thin, hyperechoic linear foci within the hyaline cartilage of the trochlea and lateral femorotibial compartment
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Diagnosis: Chondrocalcinosi
s
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Chondrocalcinosis
• Multiple causes, the most common due to calcium pyrophosphate deposition disease (CPPD)
• Others include:• Gout• Wilson disease• Hemochromatosis• Ochranosis
• Hypophosphatasia• Hyperaparathyroidism• Hypomagnesemia• Hypothyroidism
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Ultrasound of the Normal Knee
• Hyaline cartilage is normally homogeneously hypoechoic
• Trochlear and anterior surfaces of the femoral condyles are best seen with the knee flexed Trochlear
cartilage
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Ultrasound of the Normal Knee
• Sharp anterior and posterior interfaces
• Ultrasound is limited in evaluating the far inner margins of both the lateral and medial femorotibial joints Far lateral aspect of the lateral femoral
condyle
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Ultrasound of the Knee with Chondrocalcinosis
• Calcifications are within the hyaline cartilage
• Parallel to the femoral condyle
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Ultrasound of the Knee with Chondrocalcinosis
• Acoustic shadowing typical of calcifications on ultrasound are not seen because these calcifications are small and do not function as a barrier to sound penetration
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Ultrasound of the Knee with Chondrocalcinosis
• This heterogeneous calcification corresponds to meniscal (fibrocartilage) calcification seen on the ultrasound
• In our case, the patient had radiographs performed seven years prior, which also demonstrated chondrocalcinosis
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Ultrasound of the Knee with Chondrocalcinosis
The lateral meniscus is extruded into the lateral joint space in this patient secondary to meniscal tear
Fem condyle Tibial plateau
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Further Reading…
Foldes K. Knee chondrocalcinosis: An ultrasonographic study of hyalin cartilage. J of Clin Im. 2002; 26:194-196Kaushik S, et al. Effect of Chondrocalcinosis on the MR Imaging of Knee Menisci. AJR. 2001; 177:905-909.Sofka CM, Adler RS, Cordasco FA. Ultrasound diagnosis of chondrocalcinosis in the knee. Skel Rad. 2002; 31:43-45