Painful focal foot swelling, bilaterally.
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There are several well-circumscribed punched-out bony erosions with sclerotic margins, especially at first MTP joints, bilaterally. Juxta-articular soft tissue densities and swelling are also visible.
Findings of x rays are characteristic of tophaceous gout.
The typical appearance of gout on x ray evaluation is the presence of well-defined “punched-out” erosions with sclerotic margins in a marginal and juxta-articular distribution, with overhanging edges. Tophi are pathognomonic feature of gout.