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Vol. 8. Issue 1.
Pages 48-49 (January - February 2012)
Vol. 8. Issue 1.
Pages 48-49 (January - February 2012)
Images in Clinical Rheumatology
DOI: 10.1016/j.reumae.2011.04.002
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Crowned Dens Syndrome: Calcification of the Transverse Ligament of the Atlas
Calcificación del ligamento transverso del atlas: síndrome de Crowned Dens
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Elena Peñas Martíneza, M. José Moreno Martíneza, Carlos Marras Fernandez-Cida,??
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cmarras2002@yahoo.es

Corresponding author.
, Begoña Torregrosa Salab
a Servicio de Reumatología, HUVA Arrixaca, Murcia, Spain
b Servicio de Radiología, HUVA Arrixaca, Murcia, Spain
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Axial skeleton affection due to chondrocalcinosis has been associated to calcium deposits in the intervertebral disc, the yellow ligament, the fact joints and even the sacroiliac joints. Calcification of the transverse ligament of the atlas (Figs. 1–3) is an infrequent manifestation and has been denominated the Crown Dens syndrome. It mostly constitutes an asymptomatic clinical picture but may be associated with episodes of acute cervical pain, stiffness and fever, with the added diagnostic difficulties of these cases.

Fig. 1.

Cervical CT: calcification of the transverse odontoid ligament (coronal).

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Fig. 2.

Cervical CT: calcification of the transverse odontoid ligament (sagittal).

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Fig. 3.

Cervical CT: calcification of the transverse odontoid ligament (axial).

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We present the case of an 82-year-old woman who consulted us due to intense cervical pain which responded poorly to analgesics. She had a history of atrial fibrillation undergoing anticoagulation therapy, spondyloarthritis and radiologic chondrocalcinosis of the knees. Physical examination revealed spontaneous pain on the cervical spine, radiating to the occipital and mastoid regions, with stiffness and movement limitations due to pain, with no neurologic manifestations.

X-ray studies show cervical spondyloarthritis and calcification of the transverse ligament of the atlas and winged ligaments of the atlas-axis joint (Fig. 4).

Fig. 4.

Cervical MR: degenerative changes with ospteophites in the last discs with moderate repercussion on the dural sac with no images of calcification on MR.

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The Crowned Dens syndrome was described initially in 1985 by Bouvet et al.1,2 Diagnosis is based on the association of a compatible clinical picture and imaging findings, mainly calcium deposits in atlas-axis joint ligaments, visible on CT.3,4

Knowledge of this entity is important in certain cases in which it may be difficult to perform a differential diagnosis with neurological infections, polymyalgia rheumatic, giant cell arteritis, etc.

References
[1]
A. Constantin, G. Bouteiller.
Acute neck pain and fever as the first manifestation of chondrocalcinosis with calcification of the transverse ligament of the atlas. Five case-reports with a literature review.
Rev Rhum Mal Osteoartic Engl Ed, 65 (1998), pp. 582-585
[2]
P. Le Goff, Y. Pennec, C. Schwarzberg.
Acute febrile neck pain simulating a meningeal syndrome, disclosing articular chondrocalcinosis.
Rev Rhum Mal Osteoartic, 47 (1980), pp. 507-509
[3]
A. Aouba, V. Vuillemin-Bodaghi, C. Mutschler, M. De Bandt.
Crowned dens syndrome misdiagnosed as polymyalgia reumática, giant cell arteritis, meningitis or spondylitis: an análisis of eight cases.
Rheumatology, 43 (2004), pp. 1508-1512
[4]
S. Roverano, A.C. Ortiz, F. Ceccato, S.O. Paira.
Calcification of the transverse ligament of the atlas in chondrocalcinosis.
J Rheumatol, 16 (2010), pp. 7-9

Please cite this article as: Peñas Martínez E, et al. Calcificación del ligamento transverso del atlas: síndrome de Crowned Dens. Reumatol Clin. 2012;8(1):48–9.

Copyright © 2010. Elsevier España, S.L.. All rights reserved
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