Peritendinous gouty tophus of tibialis posterior

Case contributed by Dr Akos Jaray

Presentation

Swollen ankle.

Patient Data

Age: 60 years
Gender: Male

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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Case information

rID: 72376
Published: 22nd Nov 2019
Last edited: 23rd Nov 2019
Inclusion in quiz mode: Included
Institution: University of Pécs

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