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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Synonyms
- Periodontoid pseudotumor
Definitions
- Nonneoplastic low T2 signal mass posterior to odontoid process related to rheumatoid arthritis (RA), degenerative change with chronic abnormal motion, and atlantoaxial subluxation, without significant calcification
- Not to be confused with
- Crowned dens syndrome: Fever with cervicooccipital junction pain, stiffness with associated calcification of transverse ligament, and nonenhancing retroodontoid soft tissue; associated with calcium pyrophosphate dihydrate crystal deposition disease (CPPD) or hydroxyapatite deposition
- Pseudogout: Arthritis caused by CPPD crystal inflammation with symptoms like gout
- Tophaceous pseudogout: Large accumulation of material giving pattern of soft tissue tumor with mass effect/cord compression
- RA soft tissue posterior to odontoid referred to as pannus
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
- Shi J et al: Thinking beyond pannus: a review of retro-odontoid pseudotumor due to rheumatoid and non-rheumatoid etiologies. Skeletal Radiol. 48(10):1511-23, 2019
- Yu SH et al: Retro-odontoid pseudotumor without atlantoaxial subluxation or rheumatic arthritis. Korean J Neurotrauma. 12(2):180-4, 2016
- Ea HK et al: Diagnosis and clinical manifestations of calcium pyrophosphate and basic calcium phosphate crystal deposition diseases. Rheum Dis Clin North Am. 40(2):207-29, 2014
- Chang EY et al: Frequency of atlantoaxial calcium pyrophosphate dihydrate deposition at CT. Radiology. 269(2):519-24, 2013
- Mwaka ES et al: Calcium pyrophosphate dehydrate crystal deposition in the ligamentum flavum of the cervical spine: histopathological and immunohistochemical findings. Clin Exp Rheumatol. 27(3):430-8, 2009
- Taniguchi A et al: Painful neck on rotation: diagnostic significance for crowned dens syndrome. J Neurol. 257(1):132-5, 2009
- Fenoy AJ et al: Calcium pyrophosphate dihydrate crystal deposition in the craniovertebral junction. J Neurosurg Spine. 8(1):22-9, 2008
- Salaffi F et al: The crowned dens syndrome as a cause of neck pain: clinical and computed tomography study in patients with calcium pyrophosphate dihydrate deposition disease. Clin Exp Rheumatol. 26(6):1040-6, 2008
- Doita M et al: Calcium pyrophosphate dihydrate deposition in the transverse ligament of the atlas: an unusual cause of cervical myelopathy. Skeletal Radiol. 36(7):699-702, 2007
- Goto S et al: Crowned Dens syndrome. J Bone Joint Surg Am. 89(12):2732-6, 2007
- Feydy A et al: Cervical spine and crystal-associated diseases: imaging findings. Eur Radiol. 16(2):459-68, 2006
- Lin SH et al: Cervical myelopathy induced by pseudogout in ligamentum flavum and retro-odontoid mass: a case report. Spinal Cord. 44(11):692-4, 2006
- Finckh A et al: The cervical spine in calcium pyrophosphate dihydrate deposition disease. A prevalent case-control study. J Rheumatol. 31(3):545-9, 2004
- Muthukumar N et al: Tumoral calcium pyrophosphate dihydrate deposition disease of the ligamentum flavum. Neurosurgery. 53(1):103-8; discussion 108-9, 2003
- Assaker R et al: Foramen magnum syndrome secondary to calcium pyrophosphate crystal deposition in the transverse ligament of the atlas. Spine (Phila Pa 1976). 26(12):1396-400, 2001
- Baysal T et al: The crowned dens syndrome: a rare form of calcium pyrophosphate deposition disease. Eur Radiol. 10(6):1003-5, 2000
- Kakitsubata Y et al: Calcium pyrophosphate dihydrate crystal deposition in and around the atlantoaxial joint: association with type 2 odontoid fractures in nine patients. Radiology. 216(1):213-9, 2000
- Fye KH et al: Compressive cervical myelopathy due to calcium pyrophosphate dihydrate deposition disease: report of a case and review of the literature. Arch Intern Med. 159(2):189-93, 1999
- Resnick D et al: Vertebral involvement in calcium pyrophosphate dihydrate crystal deposition disease. Radiographic-pathological correlation. Radiology. 153(1):55-60, 1984
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References
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Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Synonyms
- Periodontoid pseudotumor
Definitions
- Nonneoplastic low T2 signal mass posterior to odontoid process related to rheumatoid arthritis (RA), degenerative change with chronic abnormal motion, and atlantoaxial subluxation, without significant calcification
- Not to be confused with
- Crowned dens syndrome: Fever with cervicooccipital junction pain, stiffness with associated calcification of transverse ligament, and nonenhancing retroodontoid soft tissue; associated with calcium pyrophosphate dihydrate crystal deposition disease (CPPD) or hydroxyapatite deposition
- Pseudogout: Arthritis caused by CPPD crystal inflammation with symptoms like gout
- Tophaceous pseudogout: Large accumulation of material giving pattern of soft tissue tumor with mass effect/cord compression
- RA soft tissue posterior to odontoid referred to as pannus
IMAGING
General Features
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
- Shi J et al: Thinking beyond pannus: a review of retro-odontoid pseudotumor due to rheumatoid and non-rheumatoid etiologies. Skeletal Radiol. 48(10):1511-23, 2019
- Yu SH et al: Retro-odontoid pseudotumor without atlantoaxial subluxation or rheumatic arthritis. Korean J Neurotrauma. 12(2):180-4, 2016
- Ea HK et al: Diagnosis and clinical manifestations of calcium pyrophosphate and basic calcium phosphate crystal deposition diseases. Rheum Dis Clin North Am. 40(2):207-29, 2014
- Chang EY et al: Frequency of atlantoaxial calcium pyrophosphate dihydrate deposition at CT. Radiology. 269(2):519-24, 2013
- Mwaka ES et al: Calcium pyrophosphate dehydrate crystal deposition in the ligamentum flavum of the cervical spine: histopathological and immunohistochemical findings. Clin Exp Rheumatol. 27(3):430-8, 2009
- Taniguchi A et al: Painful neck on rotation: diagnostic significance for crowned dens syndrome. J Neurol. 257(1):132-5, 2009
- Fenoy AJ et al: Calcium pyrophosphate dihydrate crystal deposition in the craniovertebral junction. J Neurosurg Spine. 8(1):22-9, 2008
- Salaffi F et al: The crowned dens syndrome as a cause of neck pain: clinical and computed tomography study in patients with calcium pyrophosphate dihydrate deposition disease. Clin Exp Rheumatol. 26(6):1040-6, 2008
- Doita M et al: Calcium pyrophosphate dihydrate deposition in the transverse ligament of the atlas: an unusual cause of cervical myelopathy. Skeletal Radiol. 36(7):699-702, 2007
- Goto S et al: Crowned Dens syndrome. J Bone Joint Surg Am. 89(12):2732-6, 2007
- Feydy A et al: Cervical spine and crystal-associated diseases: imaging findings. Eur Radiol. 16(2):459-68, 2006
- Lin SH et al: Cervical myelopathy induced by pseudogout in ligamentum flavum and retro-odontoid mass: a case report. Spinal Cord. 44(11):692-4, 2006
- Finckh A et al: The cervical spine in calcium pyrophosphate dihydrate deposition disease. A prevalent case-control study. J Rheumatol. 31(3):545-9, 2004
- Muthukumar N et al: Tumoral calcium pyrophosphate dihydrate deposition disease of the ligamentum flavum. Neurosurgery. 53(1):103-8; discussion 108-9, 2003
- Assaker R et al: Foramen magnum syndrome secondary to calcium pyrophosphate crystal deposition in the transverse ligament of the atlas. Spine (Phila Pa 1976). 26(12):1396-400, 2001
- Baysal T et al: The crowned dens syndrome: a rare form of calcium pyrophosphate deposition disease. Eur Radiol. 10(6):1003-5, 2000
- Kakitsubata Y et al: Calcium pyrophosphate dihydrate crystal deposition in and around the atlantoaxial joint: association with type 2 odontoid fractures in nine patients. Radiology. 216(1):213-9, 2000
- Fye KH et al: Compressive cervical myelopathy due to calcium pyrophosphate dihydrate deposition disease: report of a case and review of the literature. Arch Intern Med. 159(2):189-93, 1999
- Resnick D et al: Vertebral involvement in calcium pyrophosphate dihydrate crystal deposition disease. Radiographic-pathological correlation. Radiology. 153(1):55-60, 1984
