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 Transducer Unlabeled short axis oblique view of the sternoclavicular joint Unlabeled short axis oblique 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. Unlabeled long axis view of the sternoclavicular joint Unlabeled long axis view of the sternoclavicular joint 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. Coronol CT Image of Bilateral SC Joints Coronol CT image demonstrating erosive changes of the right SC joint associated with inflammatory arthropathy. #6 - Video View Video Long Axis Cine 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 cine 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 is valuable when evaluating superficial "lumps and bumps" because it can help confirm whether the finding arises from a joint, tendon, soft tissue mass, vessel, lymph node, or another structure. At the sternoclavicular joint, Calcium Pyrophosphate Deposition Disease (CPPD) may appear as joint effusion, synovial thickening, cortical irregularity, and hyperechoic punctate or linear deposits in fibrocartilage or joint fluid. CPPD should be distinguished from gout, osteoarthritis, infection, and inflammatory arthritis. Acute unilateral swelling or systemic symptoms should lower the threshold for further imaging or aspiration. References: 1. Mandl P, D’Agostino MA, Navarro-Compán V, et al. 2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice. Ann Rheum Dis. 2024;83(6):752-759. doi:10.1136/ard-2023-224771 2. Filippou G, Scirè CA, Adinolfi A, et al. Identification of calcium pyrophosphate deposition disease by ultrasound: reliability of the OMERACT definitions in an extended set of joints. Ann Rheum Dis. 2018;77(8):1194-1199. doi:10.1136/annrheumdis-2017-212542 3. Verhoeven F, Chouk M, Wendling D. Ultrasonography: a useful tool for the diagnosis of chondrocalcinosis of the sternoclavicular joint. J Rheumatol. 2016;43(6):1148. doi:10.3899/jrheum.160039
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Authors, Editors, Case Information

Unlabeled short axis oblique view of the sternoclavicular joint

Labeled short axis oblique view of the sternoclavicular joint

Unlabeled long axis view of the sternoclavicular joint

Labeled long axis view of the sternoclavicular joint

Coronol CT Image of Bilateral SC Joints

#6 - Video

#7 - Video

Interpretation

UPCOMING EVENTS

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