Gouty arthropathy

Case contributed by Dr Matt Skalski

Presentation

3 years of progressing joint pain and periarticular bumps.

Patient Data

Age: 40 years old
Gender: Male
Modality: X-ray

There are numerous periarticular masses with faint areas of calcification in the hands and wrists bilaterally. The mass along the ulnar aspect of the right wrist demonstrates mild destruction of the adjacent ulnar styloid, as well as at the 2nd PIP on the right, but all other masses are predominately without adjacent osseous destruction. 

Modality: X-ray

A large (HUGE!) tophus with irregular calcification is observed in the olecrenon bursa, without adjacent erosion/destruction of the olecrenon process. There is no joint effusion. 

Modality: X-ray

Left knee: There are tophi in the soft tissue along the medial colateral ligament and posterior to the femoral condyles. A moderately sized joint effusion is noted, with faint, cloudy chondrocalcinosis in the medial and lateral tibiofemoral joint spaces indicating intraarticular crystal deposition.  There is mild to moderate tricompartmental osteoarthritis. 

Right knee: Same as left, but more severe and with an additional large tophus in the prepatellar bursa. 

Case Discussion

The images in this case illustrate typical appearances of gouty tophi; however, they lack the typical findings of adjacent bony destruction and overhanging edges for the most part, likely due to the acute onset of the disease in this patient who had normal radiographs 3 years previously. 

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Case Information

rID: 29768
Case created: 20th Jun 2014
Last edited: 4th Jun 2016
Inclusion in quiz mode: Included

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