Presentation
Swollen ankle.
Patient Data
There are multiple small, nodular, heterogeneous, partly-echogenic foci of variable sizes with posterior acoustic shadowing in keeping with tophi. Note the turbid fluctuant content on the video!
Florid peritendinous calcification is noted in the vicinity of the tibialis posterior tendon (otherwise the tendon itself appears to be intact).
Case Discussion
Ultrasound can denote the presence of tophus in the soft tissues. The above demonstrated peritendinous calcification alone is not pathognomonic for gouty tophus. However, the patient had a history of gout and a previous dual-energy CT showed deposits of uric acid in his toes.
The turbid, fluctuant content with mottled calcification, distal shadowing, slow fluctuation and the irregular bony erosions of the small joint with adjacent microcalcification are typical findings of gout.
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