Chronic tophaceous gout

Case contributed by Dr Ahmed Abdrabou

Presentation

Recurrent attacks of right foot pain over the past 3 years. Patient had lab investigation revealed hyperuricemia.

Patient Data

Age: 30 years
Gender: Male
X-ray

Puched out erosions are seen involving the 1st, 4th and 5th metatarsal heads. No periarticular osteopenia and the joint spaces are preserved. 

MRI

MRI revealed irregular shape soft tissue masses seen adjacent to the 1st, 4th and 5th metatarsal heads which erode the underlying cortex and are assumed to be tophi. They present iso intense signal on T1, heterogeneous hyperintense signal on T2 with homogeneous avid enhancement after IV contrast administration. 

Case Discussion

Imaging findings are characteristic of gouty oligoarthropathy. The presence of hyperuricemia and lack of other joint involvement exclude systemic disease and confirm the diagnosis. 

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