Objective: To determine the usefulness of computed tomography (CT), magnetic resonance imaging (MRI), and Doppler ultrasonography (US) in providing specific images of gouty tophi. Methods: Four male patients with chronic gout with tophi affecting the knee joints (three cases) or the olecranon processes of the elbows (one case) were assessed. Crystallographic analyses of the synovial fluid or tissue aspirates of the areas of interest were made with polarising light microscopy, alizarin red staining, and x ray diffraction. CT was performed with a GE scanner, MR imaging was obtained with a 1.5 T Magneton (Siemens), and ultrasonography with colour Doppler was carried out by standard technique. Results: Crystallographic analyses showed monosodium urate (MSU) crystals in the specimens of the four patients; hydroxyapatite and calcium pyrophosphate dihydrate (CPPD) crystals were not found. A diffuse soft tissue thickening was seen on plain radiographs but no calcifications or ossifications of the tophi. CT disclosed lesions containing round and oval opacities, with a mean density of about 160 Hounsfield units (HU). With MRI, lesions were of low to intermediate signal intensity on T 1 and T 2 weighting. After contrast injection in two cases, enhancement of the tophus was seen in one. Colour Doppler US showed the tophi to be hypoechogenic with peripheral increase of the blood flow in three cases. Conclusion: The MR and colour Doppler US images showed the tophi as masses surrounded by a hypervascular area, which cannot be considered as specific for gout. But on CT images, masses of about 160 HU density were clearly seen, which correspond to MSU crystal deposits.I n previous studies we have shown that MSU crystal deposits in chronic gout may be identified by CT in the knee joints, 1 in the tendons, 2 and in subcutaneous tissues. 3 They appear as round and oval opacities having a CT attenuation in the range of 150-200 HU. This study aimed at comparing CT with magnetic resonance MR imaging and PATIENTS AND METHODSFour men with chronic tophaceous gout were examined. Their mean age was 56.3 years and the mean duration of gout 18 years. Associated disorders were hypertension and type II diabetes (patient 1), obesity and gonarthrosis (patient 2), allergy to allopurinol (patient 3), and hypertension (patient 4). Imaging of the left olecranon was carried out in patient 1, the left knee in patient 2, and the prepatellar bursa in patients 3 and 4. Identification of crystalsNeedle aspiration of synovial fluid (patients 2, 3, 4) or tophaceous material (patient 1) was made in the area which was imaged. The aspirates were examined with polarising light microscopy and a first order red filter, then they were coloured with alizarin red stain, according to the technique of Paul et al for detection of apatite.4 The samples were analysed with powder diffraction x ray by standard methods. 5Imaging technique Conventional x ray examinations were made in all the cases. CT examination was performed with a 9800 high speed advantage scanner (GE), MR...

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Amongst all imaging procedures available for the exploration of an acute non traumatic abdomen, ultrasound comprises the first line technology. Non ionising, easily accessible, cheap and usable at the bedside, this imaging technique also has the advantage of close contact with the patient, which may help to focus the exploration on painful regions. Moreover, ultrasound has not only diagnostic capabilities, but also therapeutic ones. Nevertheless, sonography has limitations, which have to be known in order to avoid misdiagnosis or inadequate reassurance. The aim of this review is to present and discuss the most recent opinions about ultrasound diagnosis of acute non-traumatic abdomen related to digestive system diseases.

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In recent years, management of abdominal pain in emergency care units (ECU) has undergone a radical change. Chronic work overload of ECU and increase in severity and complexity of cases required an optimal medical imaging method, such as ultrasound, to establish an accurate diagnosis as quickly as possible. A great variety of causes may cause acute abdominal pain and the role of sonography is to accurately distinguish between these aetiologies. For the application of sonography, perhaps more so than with other imaging methods, a perfect knowledge of sonographical characteristics and technical possibilities is essential to achieve an optimal answer. The purpose of this review is to present and discuss the sonographic characteristics of extra-digestive causes of acute abdominal pain such as splenic infarction, thoracic pathologies, urinary and gynaecologic diseases or retroperitoneal pathologies.