Abstract
Objective
To describe the different and lesser-known ultrasound features of tophi in chronic tophaceous gout.
Methods
Ultrasound images of 138 affected areas were analyzed from 31 patients with gout, using high-quality broadband linear transducers (frequency range of 8–14 MHz). Tophi were classified relative to echogenicity, echotexture, contours, number and the presence or absence of hypoechoic halo. The duration of illness was correlated with the presence of calcifications in tophi.
Results
Hyperechoic tophi were seen in 133 areas (96.3%); these were most frequently hyperechoic and heterogeneous (37.6%) or hyperechoic and heterogeneous with calcification (32.6%). Contours were found to be poorly defined in 115 (83.3%) areas. Multiple grouped tophi were seen in 85 areas (61.6%) and 50 areas (36.2%) had individual tophi. In 77 examined areas (55.8%), there was a hypoechoic halo around the tophi. There was no correlation between illness duration and presence of calcifications on tophi.
Conclusions
Tophi are generally hyperechoic, heterogeneous, with poorly defined contours, multiple grouped and surrounded by an anechoic halo. Individual tophus and the absence of association between illness duration and the presence of calcification are newly described features. This study of tophaceous gout by ultrasound may contribute to the diagnostic elucidation of patients with clinically atypical gout and show its diverse characteristic forms of presentation.
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References
Monu JU, Pope Jr TL. Gout: a clinical and radiologic review. Radiol Clin North Am. 2004;42(1):169–84.
Rettenbacher T, Ennemoser S, Weirich H, Ulmer H, Hartig F, Klotz W, et al. Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray. Eur Radiol. 2008;18(3):621–30.
Mudgal CS. Management of tophaceous gout of the distal interphalangeal joint. J Hand Surg Br. 2006;31(1):101–3.
O’Leary ST, Goldberg JA, Walsh WR. Tophaceous gout of the rotator cuff: a case report. J Shoulder Elbow Surg. 2003;12(2):200–1.
Chang CH, Lu CH, Yu CW, Wu MZ, Hsu CY, Shih TT. Tophaceous gout of the rotator cuff. A case report. J Bone Joint Surg Am. 2008;90(1):178–82.
Coombs PR, Houseman N, White R. Chronic tophaceous gout of the third flexor digitorum profundus tendon in the hand: an unusual sonography diagnosis. AJR Am J Roentgenol. 2006;187(3):W313–5.
Wurapa RK, Zelouf DS. Flexor tendon rupture caused by gout: a case report. J Hand Surg Am. 2002;27(4):591–3.
Lagoutaris EDAHB, DiDomenico LA, Rothenberg RJ. Longitudinal tears of both peroneal tendons associated with tophaceous gouty infiltration. A case report. J Foot Ankle Surg. 2005;44(3):222–4.
Perez-Ruiz F, Martin I, Canteli B. Ultrasonographic measurement of tophi as an outcome measure for chronic gout. J Rheumatol. 2007;34(9):1888–93.
Janssen T, Rayan GM. Gouty tenosynovitis and compression neuropathy of the median nerve. Clin Orthop Relat Res. 1987;216:203–6.
Wright SA, Filippucci E, McVeigh C, Grey A, McCarron M, Grassi W, et al. High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study. Ann Rheum Dis. 2007;66(7):859–64.
Gerster JC, Landry M, Dufresne L, Meuwly JY. Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography. Ann Rheum Dis. 2002;61(1):52–4.
Grassi W, Meenagh G, Pascual E, Filippucci E. “Crystal clear”-sonographic assessment of gout and calcium pyrophosphate deposition disease. Semin Arthritis Rheum. 2006;36(3):197–202.
Gentili A. The advanced imaging of gouty tophi. Curr Rheumatol Rep. 2006;8(3):231–5.
Balbir-Gurman A, Nahir AM, Braun-Moscovici Y, Soudack M. Sonographic features of a tophaceous nodule. Isr Med Assoc J. 2005;7(11):746–7.
Schuind FA, Clermont D, Stallenberg B, Remmelink M, Pasteels JL. Gouty involvement of flexor tendons. Chir Main. 2003;22(1):46–50.
Ho CF, Chiou HJ, Chou YH, Chang CY. Peritendinous lesions: the role of high-resolution ultrasonography. Clin Imaging. 2003;27(4):239–50.
Grassi W, Filippucci E, Farina A, Cervini C. Sonographic imaging of the distal phalanx. Semin Arthritis Rheum. 2000;29(6):379–84.
Moore JR, Weiland AJ. Gouty tenosynovitis in the hand. J Hand Surg Am. 1985;10(2):291–5.
Farina A, Filippucci E, Grassi W. Sonographic findings for synovial fluid. Reumatismo. 2002;54(3):261–5.
Townshend D, Pai V. Gouty tenosynovitis–more common than we think? N Z Med J. 2004;117(1188):U749.
Weniger FG, Davison SP, Risin M, Salyapongse AN, Manders EK. Gouty flexor tenosynovitis of the digits: report of three cases. J Hand Surg Am. 2003;28(4):669–72.
Mockford BJ, Kincaid RJ, Mackay I. Carpal tunnel syndrome secondary to intratendinous infiltration by tophaceous gout. Scand J Plast Reconstr Surg Hand Surg. 2003;37(3):186–7.
Champion D. Gouty tenosynovitis and the carpal tunnel syndrome. Med J Aust. 1969;1(20):1030–2.
Abrahamsson SO. Gouty tenosynovitis simulating an infection. A case report. Acta Orthop Scand. 1987;58(3):282–3.
Chuang HL, Wong CW. Carpal tunnel syndrome induced by tophaceous deposits on the median nerve: case report. Neurosurgery. 1994;34(5):919. discussion 920.
Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977;20(3):895–900.
Yu JS, Chung C, Recht M, Dailiana T, Jurdi R. MR imaging of tophaceous gout. AJR Am J Roentgenol. 1997;168(2):523–7.
Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology (Oxford). 2007;46(7):1116–21.
Nalbant S, Corominas H, Hsu B, Chen LX, Schumacher HR, Kitumnuaypong T. Ultrasonography for assessment of subcutaneous nodules. J Rheumatol. 2003;30(6):1191–5.
Blacksin MF, Ha DH, Hameed M, Aisner S. Superficial soft-tissue masses of the extremities. Radiographics. 2006;26(5):1289–304.
Benson CH, Gibson JY, Harisdangkul V. Ultrasound diagnosis of tophaceous and rheumatoid nodules. Arthritis Rheum. 1983;26(5):696.
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de Ávila Fernandes, E., Kubota, E.S., Sandim, G.B. et al. Ultrasound features of tophi in chronic tophaceous gout. Skeletal Radiol 40, 309–315 (2011). https://doi.org/10.1007/s00256-010-1008-z
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DOI: https://doi.org/10.1007/s00256-010-1008-z