Gouty tophus simulating soft tissue tumor in a heart transplant recipient

Chaoui, A.; García, Javier de Santiago; Kurt, Anne-Marie

doi:10.1007/s002560050299

Cited by 22 publications

(11 citation statements)

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“…11 MR imaging showed the tophi as structures of intermediate to low signal intensity, as already reported in previous papers. 6 10 12 These findings cannot be considered specific to gout. 12 The post-gadolinium injected images showed a peripheral enhancement of the tophus (fig 1B), which is a sign of hypervascularity in patient 2 ( fig 1B) but not in patient 1; likewise images with colour Doppler showed hypervascularity in patient 2 as well as in patients 3 and 4.…”

Section: Results Of Imaging Techniquesmentioning

confidence: 99%

Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography

Gerster

Landry²,

Dufresne³

et al. 2002

Annals of the Rheumatic Diseases

167

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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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Section: Results Of Imaging Techniquesmentioning

confidence: 99%

Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography

Gerster

Landry²,

Dufresne³

et al. 2002

Annals of the Rheumatic Diseases

167

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“…There is limited number of papers reporting gouty tophi that mimics malignancy radiologically. [9][10][11][12][13] The hand and foot lesions in our case had atypical radiographic findings with destructive bone and joint changes simulating a malignancy. Roentgenographic changes in gouty arthropathy are not sufficiently sensitive and specific for the diagnosis.…”

Section: Discussionmentioning

confidence: 95%

Unusual Gouty Tophi Simulating Malignancy

et al. 2016

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“…In these cases, allopurinol was contraindicated because of its interaction with azathioprine, whereas benzbromarone at a dose of 100 mg/day normalized the serum uric acid level and increased the urinary uric acid excretion without any effect on azathioprine. It is valuable to reemphasize the rapidity with which tophaceous gout can develop in organ-transplant patients taking cyclosporine and the unusual clinical presentations such patients may have [593][594][595][596] . The drug has also been used successfully in the treatment of familial juvenile gouty nephropathy and in a small number of patients with renal insuf fi ciency [ 585,597 ] .…”

Section: Benzbromaronementioning

confidence: 99%

Management of Hyperuricemia and Gout

Newcombe¹

2012

Gout

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Gouty tophus simulating soft tissue tumor in a heart transplant recipient

Cited by 22 publications

References 0 publications

Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography

Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography

Unusual Gouty Tophi Simulating Malignancy

Management of Hyperuricemia and Gout

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