Achilles intratendinous gouty tophus

Case contributed by Dr Dinesh Brand


Eight days of Achilles pain.

Patient Data

Age: 40 years
Gender: Male

There is significant thickening and marked heterogeneity of the distal aspect of the Achilles tendon at the calcaneal insertion. The tendon measures up to 16 mm in AP dimension.There are multiple echogenic foci of variable sizes with posterior acoustic shadowing evident consistent with florid calcifications. There is significant tendon hypervascularity on Doppler interrogation. The Achilles tendon otherwise appears intact. There is no posterior calcaneal spur demonstrated. There is inflammation of the retro-calcaneal bursa.

The features are most in keeping with Achilles intratendinous gouty tophus.
Correlation with blood uric acid is recommended. There are appearances of retrocalcaneal calcaneal bursa.

Case Discussion

Ultrasound can demonstrate urate deposition, tophus, and vascularization that are present throughout the Achilles tendon in patients with tophaceous gout 1.

Carroll et al investigated the frequency and distribution of characteristics of the Achilles tendon in patients with tophaceous gout using musculoskeletal ultrasound.

They found that, compared with age- and sex-matched control participants, patients with tophaceous gout have both disease-specific and non-specific features, including a higher prevalence of tophus, intratendinous power Doppler signal, and intratendinous hyperechoic spots. However, structural damage in the Achilles tendon was minimal in participants with gout 1.

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Case information

rID: 64191
Published: 11th Nov 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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