Calcification of the transverse ligament of the atlas in chondrocalcinosis.
OBJECTIVE
This study seek to establish the prevalence of calcification of the transverse ligament of the atlas (TLA) and of crowned dens syndrome (CDS) in patients with articular chondrocalcinosis. It also seeks to assess the main computed tomography appearances of these calcifications.


METHODS
Twenty-eight patients with articular chondrocalcinosis were prospectively evaluated for evidence of calcifications of the transverse ligament of the atlas. A group of patients with gout, fibromyalgia, and osteoarthritis were used as control.


RESULTS
Twenty-eight patients with articular chondrocalcinosis were prospectively evaluated for evidence of calcifications of the transverse ligament of the atlas. Twenty of the patients (71%) showed this calcification by computed tomography, disclosing 3 patterns of calcification: curvilinear in shape, thick, and forming a double band and mottled. Calcifications were not found in the controls (P < 0.0001). Nine patients were symptomatic (crowned dens syndrome). Patients with chondrocalcinosis and calcification of the transverse ligament of the atlas were older than the rest of the patients. Unlike the patient group, the majority of the patients in the control group were male (P = 0.02).


CONCLUSIONS
The presence of calcifications of the transverse ligament of the atlas in patients with chondrocalcinosis occurs more frequently than that reported earlier. The CT scan is the most sensitive method to detect it. Taking into account that calcifications of TLA may manifest as CDS in a high percentage of these patients, such possibility should be considered in all patients with neck pain, stiffness, fever, and inflammatory response so as to avoid invasive diagnostic methods and more aggressive treatments than the use of nonsteroidal anti-inflammatory drugs.
Roverano
Susana
S
Rheumatology Section, J. M. Cullen Hospital, Santa Fe, Argentina. susanarove@yahoo.com
Ortiz
Alberto C
AC
Ceccato
Federico
F
Paira
Sergio O
SO
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D002805:Chondrocalcinosis / Q000150:complications*; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed