Figure A Figure B A 1983 CMCC graduate, Dr. Marshall Deltoff completed his radiology residency at Los Angeles College of Chiro- practic. He is a past radiology department chairman and resi- dency coordinator at CMCC, and he initiated the radiology curriculum at UQTR. Dr. Deltoff has lectured throughout North America, and is co-author, along with Dr. Peter Kogon, DACBR, of the radiology text “The Portable Skeletal X-ray Library” published by Mosby- Yearbook of St. Louis. Dr. Deltoff can be reached at: Images Radiology Consultants, 16 York Mills Road, Toronto, Ont. M2P 2E5 Tel: (416) 512-2225 Fax: (416) 512-2226 e-mail: [email protected] SOME POINTS TO REMEMBER ABOUT CPPD: • infl ammatory joint disease resulting from deposition of calcium pyrophosphate dihydrate into the synovial fl uid; a metabolic disturbance in which there is an impaired degradation or excessive production of pyrophosphate • may be acute (more prevalent in males) or chronic (more prevalent in females) • frequently associated with diabetes mellitus • features include articular cartilage calcifi cation, with possible periarticular calcifica- tion of synovium, articular capsule, tendons, bursae • affected hyaline cartilage appears as a fi ne radiopaque line parallel to the contour of the articular cortex • affected fi brocartilage demonstrates a characteristic punctate calcification • in the knee, the menisci classically demonstrate calcification • joint destruction associated with CPPD is virtually indistinguishable from that of osteoarthritis • CPPD also tends to affect the shoulder, elbow, radiocarpal joint, hip, symphysis pubis and patellofemoral joint • joint aspiration may be necessary to confi rm the diagnosis • 42 • CANADIAN CHIROPRACTOR | OCTOBER 2008 www.canadianchiropractor.ca A 62-year-old woman presented with bilateral knee crepitus, swelling and stiff- ness. Radiographic examination reveals bilateral chondrocalcinosis. (Figures A and B) DIAGNOSIS: Calcium pyrophosphate dihydrate (CPPD) deposition disease; also known as pseudogout. Marshall Deltoff, DC, DACBR, FCCR(C)
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