Crystals in body fluids: Difference between revisions

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==Pseudogout==
==Pseudogout==
: ''Chondrocalcinosis'' redirects here.
 
*[[AKA]] ''Chondrocalcinosis''.
*[[AKA]] ''Calcium pyrophosphate dihydrate deposition disease'',<ref>URL: [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/]. Accessed on: 28 October 2011.</ref> abbreviated ''CPPD''.
*[[AKA]] ''Calcium pyrophosphate dihydrate deposition disease'',<ref>URL: [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/]. Accessed on: 28 October 2011.</ref> abbreviated ''CPPD''.
===General===
{{Main|Calcium pyrophosphate deposition}}
*Classically found in the knee.
*Associated with low bone mineral density and vascular calcification.<ref name=pmid23912799>{{Cite journal  | last1 = Abhishek | first1 = A. | last2 = Doherty | first2 = S. | last3 = Maciewicz | first3 = R. | last4 = Muir | first4 = K. | last5 = Zhang | first5 = W. | last6 = Doherty | first6 = M. | title = Association between low cortical bone mineral density, soft-tissue calcification, vascular calcification and chondrocalcinosis: a case-control study. | journal = Ann Rheum Dis | volume =  | issue =  | pages =  | month = Aug | year = 2013 | doi = 10.1136/annrheumdis-2013-203400 | PMID = 23912799 }}</ref>
 
===Radiology===
*Similar to [[osteoarthritis]] - joint space narrowing & subchondral sclerosis.<ref name=learningrads>URL: [http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm]. Accessed on: 9 October 2013.</ref>
 
Findings suggestive of CPPD:<ref name=learningrads>URL: [http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm http://www.learningradiology.com/archives04/COW%20102-CPPD/cppdcorrectpage.htm]. Accessed on: 9 October 2013.</ref>
*Subchondral cysts (large) - important.
*Intra-articular bodies, several.
*Increased narrowing of patellofemoral joint.
 
===Microscopic===
Features:
*Crystals with a rhomboid-shape.
**Positively birefringent, blue when aligned.
 
Notes:
*Memory device: ''ABC+'' = ''a''ligned ''b''lue is ''c''alcium & ''c''uboid - positively birefringent.
 
====Images====
<gallery>
Image:Pseudogout_-_intermed_mag.jpg | Pseudogout - intermed. mag. (WC)
Image:Pseudogout_-_high_mag.jpg | Pseudogout - high mag. (WC)
</gallery>
www:
*[http://ard.highwire.org/content/58/5/261/F2.large.jpg Pseudogout (highwire.org)].<ref name=pmid10225806>{{Cite journal  | last1 = Dieppe | first1 = P. | last2 = Swan | first2 = A. | title = Identification of crystals in synovial fluid. | journal = Ann Rheum Dis | volume = 58 | issue = 5 | pages = 261-3 | month = May | year = 1999 | doi =  | PMID = 10225806 | PMC = 1752883 | URL = http://ard.highwire.org/content/58/5/261.full }}</ref>
 
===Sign-out===
<pre>
KNEE - BONE AND SOFT TISSUE, RIGHT, KNEE ARTHROPLASTY:
- DEGENERATIVE JOINT DISEASE WITH SYNOVIAL HYPERPLASIA AND
  NO SIGNIFICANT INFLAMMATION.
- CRYSTALLINE DEPOSITS CONSISTENT WITH PSEUDOGOUT.
- BONE WITH THIN TRABECULAE.
</pre>
<pre>
BONE, LEFT KNEE, JOINT REPLACEMENT:
- DEGENERATIVE JOINT DISEASE.
- CRYSTALS CONSISTENT WITH PSEUDOGOUT.
- SYNOVIAL HYPERPLASIA WITH RARE GIANT CELLS.
- NEGATIVE FOR MALIGNANCY.
</pre>
====Micro====
The soft tissue section shows readily apparent rhomboid-shaped crystalline deposits
(compatible with pseudogout). The crystals polarize and have a light blue hue under
polarized light. Synovial hyperplasia is present. No lymphoid aggregates are apparent.
 
The bony section show thin bony trabeculae and cartilage with
degenerative changes (surface fibrillation, thinning).


=See also=
=See also=

Revision as of 03:07, 12 March 2014

This article deals with crystals in body fluids.

Crystals

Joint crystals

Types:[1]

  • Gout = needle-shaped, negatively birefringent, yellow when aligned.
  • Pseudogout = rhomboid-shaped, positively birefringent, blue when aligned.

Notes:

  • Pseudogout also known as CPPD = calcium pyrophosphate dehydrogenase.
  • Memory device: ABC+ = aligned blue is calcium & cuboid - positively birefringent.

Urine crystals

Types - morphology:

  • Envelope shape (calcium oxalate).
  • Diamond shape (uric acid).
  • Coffin-lid shape (struvite).
  • Hexagonal shape (cysteine).

Notes:

  • Memory devices:
    • Diamonds are see-through; ergo, uric acid stones not seen on KUB.
    • Calcium oxalate = envelope, uric acid = diamond.
  • Uric acid crystals: usually dissolve in formalin... but do not dissolve in alcohol.[2]
  • Calcium oxalate crystals are seen in the context of ethylene glycol poisoning.[3]

Diseases

Gout

Main article: Gout

Pseudogout

  • AKA Chondrocalcinosis.
  • AKA Calcium pyrophosphate dihydrate deposition disease,[4] abbreviated CPPD.
Main article: Calcium pyrophosphate deposition

See also

References

  1. ↑ Yeung, J.C.; Leonard, Blair J. N. (2005). The Toronto Notes 2005 - Review for the MCCQE and Comprehensive Medical Reference (2005 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. RH6. ISBN 978-0968592854.
  2. ↑ WG. 8 January 2010.
  3. ↑ Saukko, Pekka; Knight, Bernard (2004). Knight's Forensic Pathology (3rd ed.). A Hodder Arnold Publication. pp. 589. ISBN 978-0340760444.
  4. ↑ URL: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001458/. Accessed on: 28 October 2011.

External links

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