Ultrasound of Gout

What this episode covers

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 Click the YouTube posts tab or follow on social media for bonus teaching material posted throughout the week! Instagram: https://www.instagram.com/Radquarters/ Facebook: https://www.facebook.com/Radquarters/ X (Twitter): https://twitter.com/Radquarters Reddit: https://www.reddit.com/user/radiologistHQ/ Spotify: https://open.spotify.com/show/1fnqomovit3QxvS0uvPDBP?si=2142f24601014a63 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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