Peritendinous gouty tophus of tibialis posterior
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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).
1 case question available
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.
- Baer AN, Kurano T, Thakur UJ, Thawait GK, Fuld MK, Maynard JW, McAdams-DeMarco M, Fishman EK, Carrino JA. Dual-energy computed tomography has limited sensitivity for non-tophaceous gout: a comparison study with tophaceous gout. (2016) BMC musculoskeletal disorders. 17: 91. doi:10.1186/s12891-016-0943-9 - Pubmed