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PICTURES IN CLINICAL MEDICINE
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Crowned Dens Syndrome Tomoyoshi Tamura, Masaru Suzuki and Shingo Hori Key words: crystal deposition disease, odontoid process, computed tomography (Intern Med 54: 545, 2015) (DOI: 10.2169/internalmedicine.54.4046)
Picture 1. Picture 2.
An 87-year-old woman was transported to the emergency department of our hospital because of a 2-day history of acute-onset neck pain. The patient’s cervical motion was highly limited because of the pain. Computed tomography (CT) indicated the presence of deposits around the odontoid process (Picture 1, 2), as a result, she was diagnosed to have crowned dens syndrome (CDS). The pain quickly resolved after the administration of a nonsteroidal anti-inflammatory drug. Previous reports of CDS have been based on radiographic evidence of calcium deposits around the odontoid process (1), but neck CT is now considered to be the reference standard for making such a diagnosis. The use of radiography this diagnosis is limited due to the superposition of the osseous structure (2). Magnetic resonance imaging is
also less useful for the detection of small deposits (2). Therefore, CT examinations of the neck are crucial for making an accurate diagnosis of CDS. The authors state that they have no Conflict of Interest (COI).
References 1. Sato T, Hagiwara K, Sasaki M, Matsuno H, Akiyama O. Crowned dens syndrome. Intern Med 44: 160, 2005. 2. Viana SL, Fernandes JL, De Araújo Coimbra PP, De Mendonça JL, Freitas FM, De Carvalho Barbosa Viana MA. The “crowned dens” revisited: imaging findings in calcium crystal deposition diseases around the odontoid. J Neuroimaging 20: 311-323, 2010.
Keio University School of Medicine, Emergency and Critical Care Medicine, Japan Received for publication September 9, 2014; Accepted for publication September 18, 2014 Correspondence to Dr. Tomoyoshi Tamura, [email protected] Ⓒ 2015 The Japanese Society of Internal Medicine Journal Website: http://www.naika.or.jp/imonline/index.html
545
PICTURES IN CLINICAL MEDICINE
□
Crowned Dens Syndrome Tomoyoshi Tamura, Masaru Suzuki and Shingo Hori Key words: crystal deposition disease, odontoid process, computed tomography (Intern Med 54: 545, 2015) (DOI: 10.2169/internalmedicine.54.4046)
Picture 1. Picture 2.
An 87-year-old woman was transported to the emergency department of our hospital because of a 2-day history of acute-onset neck pain. The patient’s cervical motion was highly limited because of the pain. Computed tomography (CT) indicated the presence of deposits around the odontoid process (Picture 1, 2), as a result, she was diagnosed to have crowned dens syndrome (CDS). The pain quickly resolved after the administration of a nonsteroidal anti-inflammatory drug. Previous reports of CDS have been based on radiographic evidence of calcium deposits around the odontoid process (1), but neck CT is now considered to be the reference standard for making such a diagnosis. The use of radiography this diagnosis is limited due to the superposition of the osseous structure (2). Magnetic resonance imaging is
also less useful for the detection of small deposits (2). Therefore, CT examinations of the neck are crucial for making an accurate diagnosis of CDS. The authors state that they have no Conflict of Interest (COI).
References 1. Sato T, Hagiwara K, Sasaki M, Matsuno H, Akiyama O. Crowned dens syndrome. Intern Med 44: 160, 2005. 2. Viana SL, Fernandes JL, De Araújo Coimbra PP, De Mendonça JL, Freitas FM, De Carvalho Barbosa Viana MA. The “crowned dens” revisited: imaging findings in calcium crystal deposition diseases around the odontoid. J Neuroimaging 20: 311-323, 2010.
Keio University School of Medicine, Emergency and Critical Care Medicine, Japan Received for publication September 9, 2014; Accepted for publication September 18, 2014 Correspondence to Dr. Tomoyoshi Tamura, [email protected] Ⓒ 2015 The Japanese Society of Internal Medicine Journal Website: http://www.naika.or.jp/imonline/index.html
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