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Soft Tissue and Articular Gout

Foot pain • Xray of the Week 

54 year old male with pain and soft tissue masses of both feet. 

(Left) T1 weighted axial image demonstrating low signal intensity tophi adjacent to the first and second metatarsal phalangeal joints with associated bone erosions. Note the typical overhanging edges and sclerotic margins of the erosions.

(Right) Sagittal FSE PD weighted image with fat saturation showing a large intermediate signal intensity tophus posterior to the tibio-talar joint. There is also synovial proliferation, erosions and tibialis anterior tendon tophus formation. 

T1 weighted sagittal image demonstrating low signal intensity tophi adjacent to the first metatarsal phalangeal joint. 

Axial FSE PD weighted image with fat saturation showing a large intermediate signal intensity tophus posterior to the tibio-talar joint. There is also synovial proliferation, erosions and tibialis anterior tendon tophus formation. 

 

A vitamin E capsule is at the site of the patient’s pain. T1 weighted sagittal image demonstrating low signal intensity tophi adjacent to the tibiotalar joint with associated bone erosions. Note the typical overhanging bone and sclerotic margins of the erosions.

 

 

1. Girish G, Glazebrook KN, Jacobson JA. Advanced Imaging in Gout. AJR Am J Roentgenol. 2013;201: 515-525. 

2. Barnes CL and Helms CA. MRI of gout: a pictorial review. Int. J. Clin. Rheumatol. (2012) 7(3), 281–285.

3. Oaks J, Quarfordt SD, Metcalfe JK. MR features of vertebral tophaceous gout. AJR Am J Roentgenol. 2006;187 (6): W658-9. 

4. Yu JS, Chung C, Recht M et-al. MR imaging of tophaceous gout. AJR Am J Roentgenol. 1997;168 (2): 523-7. 

5. Perez-Ruiz F, Dalbeth N, Urresola A, et-al. Imaging of gout: findings and utility. Arthritis Res. Ther. 2009;11 (3): 232.

6. de Ávila Fernandes E, Kubota ES, Sandim GB, et-al. Ultrasound features of tophi in chronic tophaceous gout. Skeletal Radiol. 2011;40 (3): 309-15. 

 

 

Phillip Tirman, MD is the Medical Director of Musculoskeletal Imaging at the Renaissance Imaging Center in Westlake Village, California. A nationally recognized expert in the applications of MRI for evaluating MSK and spine disorders, Dr. Tirman is the co-author of three textbooks, including MRI of the Shoulder and Diagnostic Imaging: Orthopedics. He is also the author or co-author on over sixty original scientific articles published in the radiology and orthopedic literature.

All Posts by Phillip Tirman, MD

 

 

 

 

 

Kevin Rice, MD is the president of Global Radiology CME 

Dr. Rice serves as the Chair of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field.

 

 

All posts by Kevin Rice, MD

Follow Dr. Rice on Twitter @KevinRiceMD

 

 

 

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