Presentation
Pain and swelling of the great toe.
Patient Data
CT images show punched-out erosions with sclerotic margins in juxta-articular distribution involving the first metatarsophalangeal joint. Soft tissue density nodules are seen in subcutaneous tissue (Tophi).
Case Discussion
Gout is a crystal arthropathy characterized by the deposition of monosodium urate crystals within the joint and adjacent to it. These crystals are negatively birefringent in plane-polarized light 1.
Hyperuricemia is the primary risk factor for the development of gout, and two mechanisms have been postulated:
under-secretion of uric acid by kidneys
over-production of uric acid
It has an asymmetrical polyarticular distribution, with the 1st MTP being the most common site. Tophi are pathognomonic and are regarded as foreign body granulomas around the monosodium urate crystals 2.
Imaging of gout shows effusion in joints with preservation of joint space until late stages of the disease. Rat-bite erosions are a typical appearance in the case of gout. Tophi and bursitis are soft tissue imaging findings.
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