Question:

What is an imaging feature of Crowned Dens Syndrome?
1. Erosions and cystic change of the dens.
2. Soft tissue inflammatory component.
3. Erosions of the facet joints.
4. Calcifications around the dens.
5. Mass effect on the spinal cord.





Answer:

The correct answers for the question "What is an imaging feature of Crowned Dens Syndrome?" are:

1. Erosions and cystic change of the dens.

2. Soft tissue inflammatory component.

4. Calcifications around the dens.

5. Mass effect on the spinal cord.



Explanation
1. Erosions and cystic change of the dens can been seen in the inflammatory arthropathy of CPPD.  [The inflammatory reaction that occurs with the deposition of these CPPD crystals typically leads to erosions and cystic change in the dens.]

2. Soft tissue inflammatory component posterior to the dens is common. [The inflammatory reaction that occurs with the deposition of these CPPD crystals typically leads to erosions and cystic change in the dens, with the presence of a slowly enlarging inflammatory soft tissue component occurring as the disease progresses.]

3. Erosions of the facet joints is seen in rheumatoid arthritis of the cervical spine.

4. Calcifications around the dens on imaging is a requirement for the syndrome. [The entity of Crowned Dens Syndrome was first described by Bouvet et al in 1985, who described it as a clinical and radiological entity characterized by acute neck pain and evidence of calcium deposits around the dens on radiographs.]

5. Mass effect on the spinal cord can be seen in severe cases. [This soft tissue component may cause mass effect on the cervical spinal cord, but mass effect on the clivus with erosion and destruction of the inferior clivus as in our patient ,has, to our knowledge, never been described and indicates that significant mass effect may occur.



From the manuscript:
CPPD Crowned Dens Syndrome with clivus destruction: A case report
Radiology Case. 2011 Aug; 5(8):30-37


This article belongs to the MSK section.




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From the manuscript

CPPD Crowned Dens Syndrome with clivus destruction: A case report

Free full text article: CPPD Crowned Dens Syndrome with clivus destruction: A case report

Abstract
We report a case of CPPD crowned dens syndrome in an 87 year white old male with a known history of pseudogout, with clinical and radiological features characteristic of this syndrome. Interestingly, there was significant mass effect on the clivus, with clivus erosion and destruction, a finding that has not previously been described with this syndrome. The clinical and radiological characteristics of Crowned Dens syndrome, as well as CPPD are reviewed. We suggest that CPPD crowned dens syndrome may be included in the differential diagnosis when clivus destruction or erosion, in association with a soft tissue mass with calcification, is seen.






References



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