Presentation
Long-standing hand and feet pain.
Patient Data
There are periarticular erosions at the first metatarsophalangeal and second proximal interphalangeal joints as well as at the lateral tarsometatarsal joint and talonavicular joints with sparing of the joint space and articular surfaces.
Marked soft tissue swelling demonstrated over the right index finger DIP joint with destruction of the underlying middle phalanx distally and proximal aspect of the distal phalanx. There is some faint soft tissue calcification. The bony margins are benign. PIP joint and remaining joints in the right index finger are normal. Degenerative changes are seen in the DIP and PIP joints of the remaining fingers. No other bony injuries/fracture
CONCLUSION: Appearances are consistent with progressive tophaceous gout causing bony destruction.
Case Discussion
Findings are typical of gout and this patient has a known history of gout.
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