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CLINICAL IMAGES
Year : 2016  |  Volume : 143  |  Issue : 6  |  Page : 834-835

Pathognomonic acetabular cysts in camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome


Department of Orthopaedics & Traumatology, Osmania General Hospital, Afzalgunj, Hyderabad 500 012, Telangana, India

Date of Web Publication12-Oct-2016

Correspondence Address:
Ravindranath Vutukuru
Department of Orthopaedics & Traumatology, Osmania General Hospital, Afzalgunj, Hyderabad 500 012, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-5916.192082

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How to cite this article:
Vutukuru R, Reddy KK. Pathognomonic acetabular cysts in camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome. Indian J Med Res 2016;143:834-5

How to cite this URL:
Vutukuru R, Reddy KK. Pathognomonic acetabular cysts in camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome. Indian J Med Res [serial online] 2016 [cited 2019 Jun 16];143:834-5. Available from: http://www.ijmr.org.in/text.asp?2016/143/6/834/192082

An eight year old boy presented to the Orthopaedic outpatient department of Osmania General Hospital, Hyderabad, India, in January 2014 with a complaint of pain, bilateral swellings of the knee and ankle joints and difficulty squatting and sitting cross-legged [Figure 1]a, b, c. On examination, there was synovial thickening of knee joints. There was no clinical evidence of pericarditis. Echocardiogram was normal. Laboratory results for inflammatory markers were in the normal range. Synovial fluid analysis revealed a straw coloured turbid liquid.
Figure 1 (a, b). Picture showing bilateral knee swellings (black arrows). (c) The child, unable to squat because of inability to achieve full knee flexion (red arrow) of both knees, only 120 degrees of knee flexion was possible

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Radiographs of the pelvis showed an immature skeleton with large acetabular cysts, considered diagnostic of camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome. Increased joint space, flattened femoral heads, broadening of femoral neck and coxa vara [Figure 2]a, b were observed. MRI clearly demonstrated the multiple acetabular cysts [Figure 3]a, b, c, d. Aggressive physiotherapy with a global range of motion exercises for hips and knees was initiated along with paracetamol for pain relief. Eight months after the first visit, there was slight improvement in the range of motion of knees and hips.

The occurrence of multiple joint swellings (arthropathy) without inflammatory signs and deformities in hands and feet (camptodactyly) with or without pericarditis are characteristics of this syndrome. The chief differential is juvenile idiopathic arthritis, for which it is commonly mistaken.
Figure 2 (a, b). Anteroposterior (AP) and frog leg lateral views of pelvis radiographs showing large acetabular cysts (black arrows), which are pathognomonic, flattening of the femoral heads, coxa vara of the femoral necks

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Figure 3 (a, b, c, d). Coronal short tan inversion recovery (STIR) (a) and coronal, axial and sagittal T2 weighted (b, c, d) MRI images of the both hip joints showing multiple large cysts (white arrows) in the acetabulum

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    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 Noninflammatory disorders mimic juvenile idiopathic arthritis
Sulaiman M. Al-Mayouf
International Journal of Pediatrics and Adolescent Medicine. 2018;
[Pubmed] | [DOI]



 

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