Sternoclavicular Joint Cppd Arthropathy

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Sternoclavicular Joint Cppd Arthropathy

Authors, Editors, Case Information Author: Brady Fleshman, MD Affiliation: University of Missoruri Senior Editor: Derek Stokes, MD Clinical Vignette: A 72-year-old female was referred for 5 months of a "lump" at the base of the anterior neck. She initially had pain in the shoulder, which then migrated to the medial clavicle and sternoclavicular region. Prior work-up included a recent thyroid ultrasound, which was normal. Type of Probe Used: L4-12t-RS Linear Array Probe Coronol CT Image of Bilateral SC Joints Coronol CT image demonstrating erosive changes of the right SC joint associated with inflammatory arthropathy. Unlabeled short axis oblique view of the sternoclavicular joint Unlabeled short axis oblique view of the sternoclavicular joint Unlabeled long axis view of the sternoclavicular joint Unlabeled long axis view of the sternoclavicular joint Labeled short axis oblique view of the sternoclavicular joint Labeled short axis oblique view of the sternoclavicular joint with mixed echogenicity within the joint capsule suggestive of effusion and cortical irregularities of both the clavicle and sternum. Labeled long axis view of the sternoclavicular joint Labeled long axis view of the sternoclavicular joint mixed echogenicity within the joint capsule suggestive of effusion and cortical irregularities of both the clavicle and sternum. #6 - Video View Video Long Axis Video of the sternoclavicular joint from cranial to caudal with mixed echogenicity within the joint capsule and cortical irregularities of both the clavicle and sternum, and small areas of punctate hyperechogenicity within the joint space. #7 - Video View Video Short axis oblique video of the sternoclavicular joint from lateral to medial with mixed echogenicity within the joint capsule and cortical irregularities of both the clavicle and sternum, and small areas of punctate hyperechogenicity within the joint space. Interpretation Image Interpretation: Presence of a heterogeneous/mixed echogenic appearance consistent with a complex sternoclavicular joint effusion and synovial thickening noted. Cortical irregularities of the clavicle and sternum visualized at the SC joint. There was also evidence of punctate hyperechoic deposits within the joint, best visualized on the cine clips. Teaching Pearl: Point of care ultrasound can be an valuable tool for evaluation of various “lumps and bumps”. This patient's "lump" was directly over the right sternoclavicular joint. Evaluation in a sports medicine clinic with ultrasound may have prevented an unnecessary thyroid ultrasound. Given the acuity and unilateral aspect of findings, further imaging with XR and CT was completed. Possible US findings for Calcium Pyrophosphate Deposition Disease (CPPD) include thin hyperechoic bands in the hyaline cartilage, hyperechoic punctate deposits in fibrous cartilage (as seen in this case) and hyperechoic nodules in the bursa. CPPD can be differentiated from gout, in which the pathognomonic ultrasound finding is the double contour sign (urate deposits coat the cartilage surface), in addition to tophi, and a snowstorm appearance within the synovial fluid. Osteoarthritis more commonly demonstrates osteophytes with small effusions and typically lacks crystal-specific findings. However, differentiation can be challenging. CT images in this case did show erosive changes, supporting the diagnosis of CPPD arthropathy. Aspiration was attempted but no aspirate was obtained. Gamon, E., Combe, B., Barnetche, T., & Mouterde, G. (2015). Diagnostic value of ultrasound in calcium pyrophosphate deposition disease: A systematic review and meta-analysis. RMD Open, 1(1):e000118. https://doi.org/10.1136/rmdopen-2015-000118
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Authors, Editors, Case Information

Coronol CT Image of Bilateral SC Joints

Unlabeled short axis oblique view of the sternoclavicular joint

Unlabeled long axis view of the sternoclavicular joint

Labeled short axis oblique view of the sternoclavicular joint

Labeled long axis view of the sternoclavicular joint

#6 - Video

#7 - Video

Interpretation

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