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

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