Calcium pyrophosphate dihydrate deposition disease: a forgotten common arthritis in the elderly

Intra-articular aspiration to the left wrist was done; material obtained was examined under polarised microscope revealed rhomboidal-shaped crystal with positive birefringent, consistent with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. (A and B) Sonographies of bilateral triangular fibrocartilage complexes showed hyperechoeic punctuate depositions with increased in power Doppler signal. Presence of chondrocalcinosis is a useful finding as shown in our case.2 3 Ultrasound evaluation has been studied extensively and has been proposed as a diagnostic method by the European League against Rheumatism (EULAR) task force.3 4 These ultrasound studies described the shape, echogenicity and location of CPPD crystals, with sensitivity as high as 80% in hyaline cartilage and high specificity ranging 93%–100%.4 In our case, hyperechoic depositions within triangular fibrocartilage complex based on ultrasound were characteristics of CPPD crystal.