OCAD MSK

History

35F acute onset 1 week sesamoid region pain + swelling, no trauma

Figure 1 for case calcium hydroxyapatite crystal deposition disease ( RID3594 ) — Figure 1

Figure 2 for case calcium hydroxyapatite crystal deposition disease ( RID3594 ) — Figure 2

Figure 3 for case calcium hydroxyapatite crystal deposition disease ( RID3594 ) — Figure 3

Figure 4 for case calcium hydroxyapatite crystal deposition disease ( RID3594 ) — Figure 4

Figure 5 for case calcium hydroxyapatite crystal deposition disease ( RID3594 ) — Figure 5

Discussion

XRs show a small, but smoothly contoured tibial sesamoid. MRI shows a small, uniformly dark T1/T2 signal focus that corresponds to the small sesamoid (red arrow), with indistinct plantar cortical contours, intermed T1/bright T2 replacement / expansion of the remainder of where I expect the sesamoid to be. There is contiguous bright T2 signal infiltrating the Abductor Hallucis. CT shows smoothly contoured dense sclerosis of what I think is a shrunken sesamoid, with amorphous calcific deposits in the Abd Hall, FHL and plantar medial capsule. Is this all HADD, with the dense sclerotic focus representing intraosseous HADD deposit and extraosseous myotendinous and capsular deposits, or is this chronic sesamoiditis/AVN with acute pain and swelling from superimposed HADD? What do you think / advise?

Diagnosis

calcium hydroxyapatite crystal deposition disease ( RID3594 )

Hilary Umans, MD

Courtesy

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