Age / Sex : 48 / M

Chief complaint : a palpable mass of the right hand

What is your impression?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : Sekyoung Park, Kosin University Gospel Hospital

Discussion

Answer:  Gout

Findings:

Radiographs:

A soft tissue opacity mass without calcification on the dorsal aspect of the right hand

MR images:

An oval shape mass is involving the extensor hood. The mass shows relatively isointense to hypointense to muscle on T1-weighted and T2-weighted images and peripheral enhancement.

Differential Diagnosis:

Tenosyonvial GCT

Fibroma of tendon sheath

Discussion:

Gout

• Metabolic disease

• Deposit of monosodium urate monohydrate crystals (tophi)

• Clinical manifestation

• M >> F, Adults (40-60yrs)


• Lower extremities
  
  
  
  • m/c : feet, hands, wrists, elbows, knees
  
  
  
  

• Gout tophi
  
  
  
  • Variable composition : protein, fibrous tissue, crystals, hemosiderin
  
  
  • Periarticular soft tissue (m/c), intraosseous, intraarticular or extraarticular
  
  
  
  

• Radiographs:
  
  
  
  • Juxa-articular erosion with overhanging edges
  
  
  • Eccentric or asymmetric soft-tissue massed around the joint
  
  
  • Calcification of a tophus (uncommon)
  
  
  
  

• MRI


• Wide spectrum of signal intensity


• Heterogeneous low to intermediate signal intensity on both T1- and T2-weighted images (m/c)


• Heterogenous peripheral enhancement

References

• Chen CK, Yeh LR, Pan HB et al (1999) Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients. Skeletal Radiol 28:75–80


• American Journal of Roentgenology. 2003;181: 761-769. 10.2214/ajr.181.3.181076


• RadioGraphics 2000; 20:S263–S278