Learning objectives
When a patient with no history of disease presents with knee pain and a mass,
the differential diagnosis should be broadened to include crystalline arthropathy because rarely tophi may be the initial manifestation of gout.
Background
Introduction: Gout is the most common cause of inflammatory arthritis that is characterized by raised levels of uric acid in blood and deposition of monosodium urate crystals (MAS) mostly in the joints and periarticular soft tissues (1).
Tophaceous gout represents the chronic phase of the disease and may appear in ears,
fingertips,
forearms,
Achilles tendons,
knee joints,
patellar tendons and olecranon bursae (2).
However rarely they can be the initial symptom of gout and their resemblance to soft tissue masses can cause misdiagnosis.
Herein we...
Imaging findings OR Procedure Details
Case 1:
MRI showed slightly ill-defined expansive soft tissue lesion in the proximal half of patellar tendon with low signal intensity on T1 and T2 weighted images (Figure 1).
The knee joint was normal and there was no effusion.
Contrast enhanced sequences demonstrated heterogenous enhancement of the soft tissue mass (Figure 2).
Case 2:
Roentgenogram revealed lobulated,
well-defined radiopaque lesion in the soft tissue above the patella (Figure 3).
MRI showed slightly ill-defined expansive soft tissue lesion in the distal half of quadriceps tendon with...
Conclusion
Rarely the initial manifestation of gout may be tophi in tendons.
Hence when a patient with no history of disease presents with knee pain and a mass,
the differential diagnosis should include crystalline arthropathy.
References
1) Y.
Zhu,
B.
J.
Pandya,
and H.
K.
Choi.
Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008.
Arthritis &Rheumatism 2011;63(10),3136–3141.
2) Falasca GF.
Metabolic diseases: gout.
Clin Dermatol 2006;24:498–508.
3) Wernick R,
Winkler C,
Campbell S.
Tophi as the initial manifestation of gout.
Arch Intern Med 1992:152:873-876.
4) Fine JD,
Moschella SL.
Diseases of nutrition and metabolism.
In: Moschella SD.
Hurley Hi.
eds.
Dermatology.
Philadelphia: Saunders,
1985:1445.
5) Shmerling RH,
Stern SH,
Gravallese EM,...
Personal Information
* Esin Gezmis,
M.D.,
Instructor of Radiology,
Baskent University Faculty of Medicine Zubeyde Hanim Practice and Research Center,
Department of Radiology
* Hakan Boya,
M.D.,
Associate Professor,
Baskent University Faculty of Medicine Zubeyde Hanim Practice and Research Center,
Department of Orthopedics and Traumatology
* Funda Ulu Ozturk,
M.D.,
Baskent University Faculty of Medicine Ankara Hospital,
Department of Radiology
* Hasan Yerli,
M.D.,
Associate Professor,
Baskent University Faculty of Medicine Zubeyde Hanim Practice and Research Center,
Department of Radiology