Imaging findings of acute calcific periarthritis, with emphasis on magnetic resonance imaging: pictorial essay

Acute calcific periarthritis (ACP) is defined as periarticular inflammation associated with intra-articular deposits of hydroxyapatite and other basic calcium phosphate crystals. Patients with ACP present with a sudden onset of pain, together with localized swelling, as well as erythema, tenderness, and reduced range of motion. Familiarity with the clinical and radiological manifestations of ACP aids in the diagnosis and helps differentiate it from other conditions, particularly infectious or inflammatory pathologies such as septic arthritis and gout, thereby reducing the number of unnecessary diagnostic and therapeutic procedures. The objective of this pictorial essay is to illustrate the imaging findings of ACP in various joints, with an emphasis on the findings obtained by magnetic resonance imaging.

Keywords:
Periarthritis; Joint diseases; Calcinosis; Hydroxyapatites; Magnetic resonance imaging; Diagnostic imaging

Authorship

Letícia Bianco Gomes de Almeida Correspondence: Dra. Letícia Bianco Gomes de Almeida. Unidade de Diagnóstico por Imagem, Hospital Universitário da Universidade Federal de Juiz de Fora. Avenida Eugênio do Nascimento, s/nº, Dom Bosco. Juiz de Fora, MG, Brazil, 36038-330. Email: leticia.bianco@hotmail.com

Department of Diagnostic Imaging, Hospital Universitário da Universidade Federal de Juiz de Fora/Empresa Brasileira de Serviços Hospitalares (HU-UFJF/EBSERH), Juiz de Fora, MG, BrazilUniversidade Federal de Juiz de Fora/Empresa Brasileira de Serviços HospitalaresBrazilJuiz de Fora, MG, BrazilDepartment of Diagnostic Imaging, Hospital Universitário da Universidade Federal de Juiz de Fora/Empresa Brasileira de Serviços Hospitalares (HU-UFJF/EBSERH), Juiz de Fora, MG, Brazil

https://orcid.org/0009-0001-2325-3014

Marcelo Mantiolhe Martins

https://orcid.org/0000-0002-8453-0791

Vinícius Neves Marcos

https://orcid.org/0000-0002-3921-0828

Correspondence: Dra. Letícia Bianco Gomes de Almeida. Unidade de Diagnóstico por Imagem, Hospital Universitário da Universidade Federal de Juiz de Fora. Avenida Eugênio do Nascimento, s/nº, Dom Bosco. Juiz de Fora, MG, Brazil, 36038-330. Email: leticia.bianco@hotmail.com

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (7)

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Figure 1
25-year-old male patient with a three-day history of arthralgia in the metacarpophalangeal joint of the left thumb, with edema, hyperemia, and local heat. The patient had no history of trauma. Because local arthritis was suspected, an ultrasound examination was ordered. A,B: Ultrasound images showing a periarticular echogenic focus (arrow) near the radial collateral ligament of the metacarpophalangeal joint of the thumb, without posterior acoustic shadowing and with increased adjacent vascularization on power Doppler. C: Radiograph taken on the same day, confirming the presence of periarticular calcium deposits (arrow).

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Figure 2
A 47-year-old male patient underwent tomography of the cervical spine, performed for investigation of neck pain and torticollis. Calcifications can be seen anterior to the C2 odontoid process, affecting the area of the anterior longitudinal ligament (arrowheads in A) and extending to the longus colli muscle of the neck (arrow in B).

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Figure 3
A 56-year-old female patient with a seven-day history of shoulder pain underwent magnetic resonance imaging and subsequent computed tomography. A: Sagittal T2 image with fat saturation showing low signal foci (arrow) in the posterosuperior capsulolabral region of the shoulder, with edema of adjacent soft tissues. B: Sagittal T1-weighted image showing foci with low signal intensity in the posterosuperior capsulolabral region (arrow). C: Sagittal computed tomography reconstruction demonstrating foci of calcification (arrow).

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Figure 4
A 44-year-old male patient with a two-day history of pain in the medial aspect of the knee and a history of contusion due to a fall from standing height 20 days prior. A: Axial T2-weighted image with fat saturation, showing foci with low signal intensity (arrows), together with edema in the adjacent soft tissues and a pattern of bone edema in the medial femoral condyle. B: Coronal T2-weighted image with fat saturation, showing a small focus with low signal intensity, related to intraosseous calcific migration, with a pattern of bone edema, in the femoral condyle (arrow).

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Figure 5
A 54-year-old male patient with pain and swelling in the wrist underwent magnetic resonance imaging for investigation of suspected septic arthritis. A: Sagittal T2-weighted image with fat saturation, showing low signal foci (arrows) in the carpal tunnel region, deep near the flexor tendons, with intense edema of adjacent soft tissues. B,C: Axial T2-weighted and T1-weighted images (B and C, respectively), showing low signal-intensity foci (arrows) within the carpal tunnel, with adjacent soft tissue edema extending to the flexor tendons, without proliferative synovitis or bone edema that would suggest inflammatory or septic arthritis.

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Figure 6
A 63-year-old male patient with pain in the thumb and suspected arthritis. A: Coronal T2-weighted image with fat saturation, showing a small focus of low signal intensity (arrow), with edema in the adjacent adipose planes. Note also the subchondral edema and cystic changes in the head of the proximal phalanx of the thumb. B,C: Unenhanced axial T1-weighted image (B) and contrast-enhanced T1-weighted image with fat saturation (C), showing a small focus of low signal intensity (white arrows) and enhancement in the adipose planes (yellow arrows), without proliferative synovitis that would suggest inflammatory or septic arthritis.

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Figure 7
A,B: A 35-year-old male patient with pain in the medial aspect of the knee and suspected ligament injury. Coronal and axial T2-weighted images with fat saturation (A and B, respectively), revealing a focus of low signal intensity (arrows) in the medial capsular region of the knee, with edema of adjacent soft tissues. C,D: A 55-year-old male patient with a confirmed diagnosis of gout. Coronal and axial T2-weighted images with fat saturation (C and D, respectively), showing a soft tissue mass involving the medial collateral ligament, capsular structures, and pes anserine tendons, consistent with a gouty tophus (white arrows), with intraosseous extension (yellow arrows).The foci of urate crystal deposition (gouty tophi) present an intermediate signal, and the typical location, near ligaments and tendon structures, is a clue to distinguish gouty tophi from ACP.

Figure 1 25-year-old male patient with a three-day history of arthralgia in the metacarpophalangeal joint of the left thumb, with edema, hyperemia, and local heat. The patient had no history of trauma. Because local arthritis was suspected, an ultrasound examination was ordered. A,B: Ultrasound images showing a periarticular echogenic focus (arrow) near the radial collateral ligament of the metacarpophalangeal joint of the thumb, without posterior acoustic shadowing and with increased adjacent vascularization on power Doppler. C: Radiograph taken on the same day, confirming the presence of periarticular calcium deposits (arrow).

Figure 2 A 47-year-old male patient underwent tomography of the cervical spine, performed for investigation of neck pain and torticollis. Calcifications can be seen anterior to the C2 odontoid process, affecting the area of the anterior longitudinal ligament (arrowheads in A) and extending to the longus colli muscle of the neck (arrow in B).

Figure 3 A 56-year-old female patient with a seven-day history of shoulder pain underwent magnetic resonance imaging and subsequent computed tomography. A: Sagittal T2 image with fat saturation showing low signal foci (arrow) in the posterosuperior capsulolabral region of the shoulder, with edema of adjacent soft tissues. B: Sagittal T1-weighted image showing foci with low signal intensity in the posterosuperior capsulolabral region (arrow). C: Sagittal computed tomography reconstruction demonstrating foci of calcification (arrow).

Figure 4 A 44-year-old male patient with a two-day history of pain in the medial aspect of the knee and a history of contusion due to a fall from standing height 20 days prior. A: Axial T2-weighted image with fat saturation, showing foci with low signal intensity (arrows), together with edema in the adjacent soft tissues and a pattern of bone edema in the medial femoral condyle. B: Coronal T2-weighted image with fat saturation, showing a small focus with low signal intensity, related to intraosseous calcific migration, with a pattern of bone edema, in the femoral condyle (arrow).

Figure 5 A 54-year-old male patient with pain and swelling in the wrist underwent magnetic resonance imaging for investigation of suspected septic arthritis. A: Sagittal T2-weighted image with fat saturation, showing low signal foci (arrows) in the carpal tunnel region, deep near the flexor tendons, with intense edema of adjacent soft tissues. B,C: Axial T2-weighted and T1-weighted images (B and C, respectively), showing low signal-intensity foci (arrows) within the carpal tunnel, with adjacent soft tissue edema extending to the flexor tendons, without proliferative synovitis or bone edema that would suggest inflammatory or septic arthritis.

Figure 6 A 63-year-old male patient with pain in the thumb and suspected arthritis. A: Coronal T2-weighted image with fat saturation, showing a small focus of low signal intensity (arrow), with edema in the adjacent adipose planes. Note also the subchondral edema and cystic changes in the head of the proximal phalanx of the thumb. B,C: Unenhanced axial T1-weighted image (B) and contrast-enhanced T1-weighted image with fat saturation (C), showing a small focus of low signal intensity (white arrows) and enhancement in the adipose planes (yellow arrows), without proliferative synovitis that would suggest inflammatory or septic arthritis.

Figure 7 A,B: A 35-year-old male patient with pain in the medial aspect of the knee and suspected ligament injury. Coronal and axial T2-weighted images with fat saturation (A and B, respectively), revealing a focus of low signal intensity (arrows) in the medial capsular region of the knee, with edema of adjacent soft tissues. C,D: A 55-year-old male patient with a confirmed diagnosis of gout. Coronal and axial T2-weighted images with fat saturation (C and D, respectively), showing a soft tissue mass involving the medial collateral ligament, capsular structures, and pes anserine tendons, consistent with a gouty tophus (white arrows), with intraosseous extension (yellow arrows).The foci of urate crystal deposition (gouty tophi) present an intermediate signal, and the typical location, near ligaments and tendon structures, is a clue to distinguish gouty tophi from ACP.

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Imaging findings of acute calcific periarthritis, with emphasis on magnetic resonance imaging: pictorial essay

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[1] Correspondence: Dra. Letícia Bianco Gomes de Almeida. Unidade de Diagnóstico por Imagem, Hospital Universitário da Universidade Federal de Juiz de Fora. Avenida Eugênio do Nascimento, s/nº, Dom Bosco. Juiz de Fora, MG, Brazil, 36038-330. Email: leticia.bianco@hotmail.com