In this radiology lecture, we review the ultrasound appearance of gout!

Key teaching points include:

• Gout is a crystal arthropathy due to monosodium urate crystal deposition in and around joints


• Most common in males over age 40


• Risk factors: Metabolic (hyperuricemia, obesity, diabetes, hypertension), renal (chronic kidney disease), dietary (high purine foods, sugary drinks, alcohol), and genetic (family history)


• Typically presents as acute monoarthritis with a red, inflamed, swollen joint. First metatarsophalangeal joint most common site of involvement (podagra)


• Can progress to asymmetric polyarticular disease and chronic tophaceous gout


• Ultrasound findings include: Joint effusion +/- hyperechoic foci (crystals/microtophi), synovial hypertrophy, and erosions typically at medial aspect of distal first metatarsal


• Erosions are juxtaarticular in distribution with overhanging edges yielding a “punched-out” appearance


• Gouty tophus: Amorphous, echogenic area containing internal hyperechoic foci surrounded by an anechoic inflammatory halo. May have associated cortical erosions


• Tophi may involve tendons, tendon sheaths, and bursae. Other common sites include olecranon region (elbow), patellar and popliteal tendons (knee)


• Double contour sign, AKA urate icing: Hyperechoic monosodium urate crystals coating hyaline cartilage surface. Disappears when serum urate levels drop below 6 mg/dL*


• Distinct from chondrocalcinosis seen in calcium pyrophosphate deposition disease which will have echogenic crystals within cartilage as opposed to on surface

References:

• *Thiele RG, Schlesinger N. Ultrasonography shows disappearance of monosodium urate crystal deposition on hyaline cartilage after sustained normouricemia is achieved. Rheumatol Int. 2010;30(4):495–503


• Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. 3rd ed. Elsevier; 2018

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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This video is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional.

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