2004 Texas Radiological Society UNKNOWN CASES Musculoskeletal 1

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2004 Texas Radiological SocietyUNKNOWN
CASESMusculoskeletal 1

• Justin Q. Ly, MD
• Douglas P. Beall, MD
• Wilford Hall Medical Center
• San Antonio, TX

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MUSCULOSKELETAL

• 54-year-old diabetic male
• Worsening joint stiffness involving hands
• History of progressive arthralgia (fingers,
  wrists, knees, and shoulders)

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2004 Texas Radiological SocietyDiagnosis
forMusculoskeletal 1 Case

• Justin Q. Ly, MD
• Douglas P. Beall, MD
• Wilford Hall Medical Center
• San Antonio, TX

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Imaging Findings

• OA-type changes in an atypical distribution
• Most severe involvement of the hands (MCP jts) gt
  larger jts shoulder/knee
• Large beak-like ostseophytes arising from radial
  aspects of all four MC heads, bilaterally
• Dense liver and spleen suggesting iron deposition

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Hemochromatosis Arthropathy

• HEMOCHROMATOSIS
• Primary-inherited massive iron absorpt
  throughout body
• Secondary-increased iron intake, mult blood
  transfusions
• Disease of iron deposition causing tissue damage
  
• Bronze pigmentation
• Cirrhosis
• Diabetes
• Cardiac failure
• Arthropathy
• H. ARTHROPATHY
• Arthropathy up to 50 of pts w/hemochromatosis
• Onset 40 - 60 yrs
• 10-20X more freq males

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Hemochromatosis Arthropathy

• CLINICAL
• Pain, swelling, stiffness
• Initially small jts of hands then larger and
  wt-bearing jts
• Metacarpal jts bilat, symmetrical uniform jt
  space loss
• All 4 metacarpals
• Progressive
• PATHOLOGY
• both iron and CPPD crystals may accumulate in
  same jt, noninflammatory
• RADIOGRAPHY
• Chondrocalcinosis related to CPPD crystal
  deposition in hemochromatosis---up to 60

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Hemochromatosis Arthropathy

• RADIOGRAPHY
• Arthropathy nearly identical to idiopathic CPPD
  crystal deposition dz (large subchondral cysts,
  uniform jt space loss, involvement of unusual
  artic sites OA findings in sites atypical for
  OA) with subtle findings more typical of hemoch
• Midcarpal and carpometacarpal jts (more
  widespread involvement of wrist)
• Osteoporosis
• Distinctive radial aspect MC head beak-like
  phytes ( larger )
• All 4 metacarpals involved (2nd/3rd CPPD)
• ABSENCE of rapidly progressive neuropathic-like
  jt damage as seen in CPPD

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Large, beak-like osteophytes involving all 4 MC
heads Large subchondral cysts Subchondral
sclerosis Mild Joint space narrowing
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2004 Texas Radiological SocietyUNKNOWN CASES

• Justin Q. Ly, MD
• Douglas P. Beall, MD
• Wilford Hall Medical Center
• San Antonio, TX

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