Gout (Gouty Arthritis) - MSK Radiology
Imaging Findings:
• Eccentric soft-tissue densities surrounding the third proximal interphalangeal joint with joint-space narrowing and juxtaarticular erosions.
• Juxtaarticular erosions with overhanging edges and well circumscribed sclerotic margins. These are CLASSIC gouty erosions.
• Gouty tophus:
- T1 sequence: Intermediate homogeneous signal intensity.
- T2 sequence: Variable appearance with mixed signal. Most commonly intermediate-low signal & heterogeneous.
Case description:
• This patient had a palpable mass and NO prior signs or clinical history of gout. Therefore, the hand surgeon had a clinical suspicion of other entities and/or mass.
• This case should be diagnosed ON THE X-RAY! Juxtaarticular corticated erosions with overhanging edges and soft-tissue
tophi...
- Be wary of interpreting only MRI without corresponding radiograph, may lean toward other diagnoses...
- **MSK rads: DO NOT interpret MRI without accompanying radiograph!
• Gout can present anywhere with atypical location. Gout is relatively common, so maintain high index of suspicion.
Differential diagnosis:
• Inflammatory Arthritides (RA, CPPD) - Can have similar appearance, usually joint space is disproportionately narrowed and diffuse chondral disease.
• PVNS/Giant Cell Tumor Tendon Sheath - Nodular mass which can have erosions. Has blooming on MRI GRE sequence.
Dr. Donald von Borstel @DrvonBorstel
#Gout #Gouty #Arthritis #mri #clinical #Radiology #diagnosis #msk #rheumatology
