Polyarticular foot gout on dual energy CT

Case contributed by Dr Andrew Dixon

Presentation

Diabetic foot ulcer. ? Osteomyelitis.

Patient Data

Age: 80 years
Gender: Male

Erosion of the distal medial aspect of the first proximal phalanx with adjacent subtle increased density within the soft-tissue. Impression of increased density with soft-tissues medial to the first metatarsal head. The possibility of gout is raised as the cause for the proximal phalanx erosion. 

CT

Dual energy CT

Generalized edema of the foot and ankle.  Well-defined para articular erosion of the first proximal phalangeal head medially.  Near circumferential to this articulation is a high attenuation crystal deposition corresponding to monosodium urate on dual energy CT. Further MSU deposition of the third DIP joint, second MTP joint, mid foot involving all of the TMT joints and the navicular-cuneiform articulation. There is also MSU deposition of the sinus tarsi and involving the lateral ankle ligament complex.

Case Discussion

A case of acute polyarticular gout confirmed with dual energy CT. 

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Case information

rID: 61984
Published: 25th Aug 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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