Clinical Image. Tophaceous Gout of the Lumbar Spine: MR Findings

Miller, Leslie J.; Pruett, Steven W.; Losada, Richard; Fruauff, Arthur A.; Sagerman, Paul

doi:10.1097/00004728-199611000-00028

Cited by 39 publications

(13 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On MRI, tophaceous deposits in the spine produce low signal on both T1-and T2-weighted images and enhance with gadolinium administration. 11,17,24,26,31,33,37 The intervertebral disc spaces, vertebral bodies, facet joints, and adjacent posterior osseous elements and epidural space could all be involved; however, (9) M 56 no history back pain, radiculopathy laminectomy improved Mekelburg, 2000 (29) M 60 no history back pain conservative improved Thornton, 2000 (37) M they are nonspecific changes and can be found in other pathology such as infections. The definitive diagnosis is made by biopsy.…”

Section: Discussionmentioning

confidence: 99%

Spinal Gout

Draganescu¹,

Leventhal²

2004

JCR: Journal of Clinical Rheumatology

View full text Add to dashboard Cite

Spinal involvement is considered to be a rare complication of gout. We report a case of a 48-year-old woman with chronic tophaceous gout, recently desensitized to allopurinol, who presented with an L4 radiculopathy. A magnetic resonance image (MRI) of the lumbosacral spine revealed an extradural process at L4 level. Three months before this episode, for unrelated reasons, the patient had an MRI of her entire spine, which was normal. Laminectomy was performed revealing a large gouty tophus. The fact that a large gouty tophus formed over this short a period of time causing neurologic symptoms highlights the importance of aggressive medical management of patients with longstanding tophaceous gout with urate-lowering agents. Spinal extradural gout could lead to neurologic deficits necessitating emergent surgery for decompression, exposing the patient to further risk. Every effort should be made to lower the serum uric acid level by maximizing the pharmacologic regimen and, if necessary, desensitizing the patient, like in our case, if there is a history of allergy to allopurinol.

show abstract

Section: Discussionmentioning

confidence: 99%

Spinal Gout

Draganescu¹,

Leventhal²

2004

JCR: Journal of Clinical Rheumatology

View full text Add to dashboard Cite

show abstract

“…Characteristically, tophi have homogeneous low signal intensity, similar to muscle on T1-weighted images [18]. On T2-weighted images, the signal characteristics of tophi vary from homogeneous high signal intensity [18,19] to homogeneous low signal intensity [4,20,21]. However, signal intensity on the T2-weighted images may be heterogeneous due to urate crystals or calcium deposition, making distinction from neoplasm difficult in a patient without clinically diagnosed gout.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

The advanced imaging of gouty tophi

Gentili

2006

Curr Rheumatol Rep

View full text Add to dashboard Cite

Gout is a metabolic disorder in which there is hyperuricemia caused by an increase in production or a decrease in excretion of uric acid. Long-lasting hyperuricemia causes the deposition of monosodium urate crystals in the joints and soft tissues, triggering gouty arthritis and, if not properly treated, the formation of gouty tophi. The diagnosis of gout is usually based on clinical presentation and laboratory examinations, long before any abnormality can be demonstrated with imaging. Radiography is the primary imaging modality used in the initial evaluation of gouty arthritis. Ultrasonography, CT, MRI, and nuclear medicine are seldom necessary. Occasionally a tophus has an unusual presentation and simulates neoplasm or infection prompting the utilization of cross-sectional imaging for further evaluation and surgical planning. Cross-sectional imaging is also used in areas that are difficult to visualize on radiographs such as spine, sacroiliac joints, and soft tissues.

show abstract

“…2,3 Only a single study reported two patients with involvement of the lacrimal sac. 4 Our case involves this rare tumour within the submucosa of the lacrimal sac with unique clinical and staining features.…”

Section: Commentmentioning

confidence: 90%

“…MR findings of gouty tophi within the appendicular 3 and axial 4 skeleton have been reported as intermediate (isointense to muscle) and occasionally of low signal intensity on T1-weighted images. 5 The findings on T2-weighted images have been more variable.…”

Section: Commentmentioning

confidence: 99%