Presentation
Acute onset foot pain. Hyperuricemia.
Patient Data
Faintly hyperdense soft tissue (probably representing tophi) is seen along the bases of the 3rd, 4th, and 5 metatarsals with adjacent punched-out (rat bite) juxta-articular erosions with overhanging edges.
Small intraarticular erosion is seen along the talar surface.
Multifocal juxtarticular punched out erosions are seen involving bases of 3rd, 4th, and 5 metatarsals with intervening soft tissue possibly representing tophi. The soft tissue shows homogenous post contrast enhancement.
Mild edema is seen in base of 4th metatarsal likely indicative of acute exacerbation.
Case Discussion
Tophi are monosodium urate crystal deposits usually involving the juxta-articular soft tissues in patients with elevated uric acid levels. There are associated juxta-articular erosions with overhanging edges.
Tophaceous gout is usually associated with 1st metatarsophalangeal joint. This case is good example of characteristic findings but atypical location for gout.
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