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Age / Sex : 64 / M
Age / Sex : 64/M
Chief complaint : Swelling and pain,
right wrist (duration: 1 week)
What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)
Courtesy : Guen Young Lee, Chung-Ang University Hospital
Diagnosis: Gouty arthritis
Discussion
Findings:
(1)
Increased
opacity around wrist joint on plain radiograph, especially in ulnocarpal joint,
indicative of tophi deposition.
(2)
Bony
erosions in carpal bones, 3rd-4th metacarpal bases,
distal radius.
(3)
Thick
enhancing synovitis with multifocal erosions in right wrist including
surrounding extensor and flexor tendon sheaths.
Differential Diagnosis:
Rheumatoid arthritis, Tuberculosis arthritis.
Diagnosis:
Gouty
arthritis.
Discussion:
Gout is a
chronic metabolic disease related to hyperuricemia. Tophi is so called as a
deposit of monosodium urate, which may be located anywhere in the body.
Cilnical manifestation may be various from acute gouty arthritis to chronic
tophaceous arthritis in cases of the joint involvement. On MRI, tophi shows
intermediate signal intensity on T1 and T2 weighted images with strong
enhancement. Multiple bone erosions and bone marrow edema are accompanied
usually. Thick synovitis and joint effusion are seen, which are commonly also in
septic arthritis or rheumatoid arthritis. Based on clinical history and
laboratory findings, gout may be diagnosed in addition to imaging findings. In
some cases, US-guide synovial biopsy and eletromicroscopic evaluation may be
helpful in the differential diagnosis.
References:
Yu JS, Chung C, Recht M, Dailiana T, Jurdi R.
MR imaging of tophaceous gout. AJR Am J Roentgenol. 1997
Feb;168(2):523-7.
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