MSK ultrasound, knee chondrocalcinosis, knee ultrasound

1. Ultrasound Case of the Month
November 2013

2. 81 year old woman with
chronic left knee pain

3. Grayscale Images of the Left Knee
Trans image at the trochlea
(knee flexed)
Trans image at the far lateral
aspect of the femorotibial
joint

4. Grayscale Images of the Left Knee
There are thin, hyperechoic linear foci within the hyaline cartilage
of the trochlea and lateral femorotibial compartment

5. Diagnosis:
Chondrocalcinosis

6. Chondrocalcinosis
• Multiple causes, the most common due to
calcium pyrophosphate deposition disease
(CPPD)
• Others include:
•
•
•
•
Gout
Wilson disease
Hemochromatosis
Ochranosis
•
•
•
•
Hypophosphatasia
Hyperaparathyroidism
Hypomagnesemia
Hypothyroidism

7. Ultrasound of the Normal Knee
• Hyaline cartilage is
normally
homogeneously
hypoechoic
• Trochlear and anterior
surfaces of the femoral
condyles are best seen
with the knee flexed
Trochlear
cartilage

8. Ultrasound of the Normal Knee
• Sharp anterior and
posterior interfaces
• Ultrasound is limited
in evaluating the far
inner margins of both
the lateral and medial
femorotibial joints
Far lateral aspect of the lateral femoral
condyle

9. Ultrasound of the Knee with
Chondrocalcinosis
• Calcifications are
within the hyaline
cartilage
• Parallel to the
femoral condyle

10. Ultrasound of the Knee with
Chondrocalcinosis
• Acoustic shadowing
typical of calcifications
on ultrasound are not
seen because these
calcifications are small
and do not function as a
barrier to sound
penetration

11. Ultrasound of the Knee with
Chondrocalcinosis
• In our case, the patient had
radiographs performed seven
years prior, which also
demonstrated chondrocalcinosis
• This heterogeneous calcification
corresponds to meniscal
(fibrocartilage) calcification seen
on the ultrasound

12. Ultrasound of the Knee with
Chondrocalcinosis
Fem condyle
Tibial plateau
The lateral meniscus
is extruded into the
lateral joint space in
this patient
secondary to
meniscal tear

13. Further Reading…
Foldes K. Knee chondrocalcinosis: An
ultrasonographic study of hyalin cartilage. J of
Clin Im. 2002; 26:194-196
Kaushik S, et al. Effect of Chondrocalcinosis on the
MR Imaging of Knee Menisci. AJR. 2001; 177:905909.
Sofka CM, Adler RS, Cordasco FA. Ultrasound
diagnosis of chondrocalcinosis in the knee. Skel
Rad. 2002; 31:43-45