Generalised oedema 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.