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Polarized MicroscopyAka: Synovial Fluid Crystals

Monosodium Urate (MSU) Crystals: Gout
1. Needle-shaped
2. Frequently intracellular
3. Strongly negatively birefringent
Calcium Pyrophosphate Dihydrate (CPPD): Pseudogout
1. Rod or rhomboidal shaped
2. Weakly positive birefringent
Basic Calcium Phosphate (BCP): Calcific periarthritis
1. Description
  1. Clumps and globules
  2. Non-birefringent
2. Conditions
  1. Chronic BCP arthritis
  2. Milwaukee shoulder-knee syndrome
  3. Mixed BCP-CPPD disease (See above)
  4. Osteoarthritis
  5. Metastatic calcinosis
Calcium Oxalate
1. Description
  1. Variable bipyramidal morphology
  2. Strongly positively birefringent
2. Conditions
  1. Chronic dialysis arthritis
  2. Arthritis of primary oxalosis
Cholesterol Crystals or Lipid Microspheres
1. Description
  1. Flat, rectangular plates
  2. Notched corners, maltese crosses
  3. Strongly negative birefringent
2. Conditions
  1. Chronic inflammatory arthritis
  2. Acute Polyarthritis
Cryoglobulin Crystals: Paraproteinemias
1. Polygonal Shaped
2. Positively birefringent
Other Crystals
1. Corticosteroid Crystals: Arthritis flare post injection
  1. Birefringent Crystals
2. Cystine Crystals: Cystinosis
3. Xanthine Crystals: Xanthinuria
4. Charcot-Leyden Crystals: Hypereosinophilic syndromes
5. Aluminum phosphate: Hemodialysis
6. Talc from exam gloves (Artifact)
7. Apatite (Stained by Alizarin red S)

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 8/14/2009. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.