Age / Sex : 50 / M

Chief complaint : right knee pain
Past hx; S/P Arthroscopic synovectomy, right knee

What is your diagnosis?

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

Courtesy : 이민희 (Min Hee Lee), 울산의대 서울아산병원 (University of Ulsan College of Medicine, Asan Medical Center)

Tophaceous gout

Discussion

Findings
1. Intraarticular soft tissue nodular lesions showing intermediate to low SI on T2WI, and inhomogenous peripheral, internal enhancement mainly in pericruciate area, right knee
2. Irregular synovial thickening with enhancement, and joint effusion in right knee
3. Bulging-out soft tissue nodular lesions at both ankles, and bone erosions with overhanging edges at right medial and lateral malleoli

References
1. Sheldon PJ, et al. Imaging of intraarticular masses. Radiographics 2005:25:105-119
2. Girish G, et al. Advanced imaging in gout. AJR 2013;201:515-525
3. Ko KH, et al. Tophaceous gout of the knee. J Clin Rheumatol 2010;16:209-214