Search

To the Editor .—We wish to make some points about the report by Mogi et al 1 in the October 1987 issue of theArchivesof a case of chondrocalcinosis of the temporomandibular joint. Two articles detailing cases of calcium pyrophosphate dihydrate (CPPD) arthropathy of the temporomandibular joint were not included by Mogi et al in their discussion. In the June 1985 issue of theArchives, Zemplenyi and Calcaterra 2 reported an example of facial swelling caused by a calcified mass that was found to be due to CPPD arthropathy. Hutton et al 3 have documented more recently three acute cases in elderly women, two of whom had small deposits of chondrocalcinosis in the temporomandibular joint. Mogi et al included in their review of the literature a report by Good and Upton 4 of a patient with acute left temporomandibular joint pain and swelling in whom bilateral degenerative changes were

A 61-year-old man had a tophus on the third finger of his right hand. There was no history of arthritis, no laboratory abnormality, and no chondrocalcinosis. Crystalline material from the tophus was identified as calcium pyrophosphate dihydrate by x-ray diffraction. ( JAMA 244:1711-1712, 1980)

A massive solitary tophus containing calcium pyrophosphate dihydrate (CPPD) crystals was resected from the distal clavicle and proximal acromion of a 62-year-old man who presented with a painful shoulder mass. The diagnosis was confirmed histologically and by X-ray diffraction. CPPD crystal deposition was found within bone, however, the articular cartilage was not involved. Other unusual features of the case include the size of the lesion, the monoarticular presentation and a peculiar discoloration of the overlying skin. The clinical presentation and radiographic features were initially consistent with a malignant process; thus the case demonstrates that CPPD arthropathy should be included in the differential diagnosis of periarticular tumors.