Pain in great toe for last year. No prior investigations were done.
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Characteristic T1 hypointense periarticular soft tissue rim is seen at 1st metatarsophalangeal joint, suggesting tophus.
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On further investigation, patient was found to have hyperuricemia, and diagnosis was confirmed as gouty arthritis.
As evident in the scans, there is no bony erosion. Patient came to me with a plain X-ray (not included here) a month back, which was normal. As the soft tissue swelling is hardly noticeable, and bony erosions are absent, plain radiograph may be misleading.
Typical presentation of pain in great toe should be evaluated by the MRI, which can detect gout in early stages, as seen in this case.