Tophaceous gout in the sternoclavicular joint

Abstract

Gouty arthritis commonly occurs in peripheral synovial joints and involvement in the thoracic cage is extremely rare. We report a case of a 52-year-old presenting with a painful bony mass in her sternal notch. Imaging demonstrated a lobulated calcified and necrotic lesion causing mass effect on adjacent structures. Excision biopsy confirmed a benign cystic lesion with amorphous material containing needle-shaped refractile crystals suggestive of uric acid. Tophaceous gout was diagnosed. Presence of a periarticular mass with characteristics of gout should warrant investigation with biopsy and imaging. This can prevent misdiagnosis of malignancy and avoid unnecessary surgery in asymptomatic lesions.

Clinical image: tophus in the sternoclavicular joint

“…Gout typically manifests as an acute episode of synovitis with the lower extremities being the most frequently affected area. However, our case showed the tophaceous gout in the sternoclavicular joint, which is very rare, with only three previous cases reported in the literature 1–3. Joints with history of chronic injuries often exhibit a higher susceptibility to gout 4.…”

Involvement of anterior chest structures accompanied with chest pain in patients with gout

“…Seven patients had peripheral joint gout or risk factors for monosodium urate crystal deposits such as hyperuricemia, poorly controlled type 2 diabetes, obesity, alcohol intake, overweight, renal insufficiency, and cardiovascular disease before being diagnosed with gout presenting with anterior chest pain. Only 1 patient had no risk factors or family history and later presented with a painful, increasing bony mass in the sternal notch that resembled a malignant tumor [ 3 ]. Of all the sites of gout attacks, the sternoclavicular joint was the most common ( n = 4), the others being the costal cartilage ( n = 2) and manubriosternal joint ( n = 2).…”

“…After screening the titles and abstracts and the references of the included papers, eight articles were found to be relevant. The eligible articles included 8 case reports [2][3][4][5][6][7][8][9]. A total of 8 patients were identified, with a male/female ratio of 7/1 and a mean age of 52 years (range: 44-61), with a median age of 52 years (Table I).…”

“…nant tumor [3]. Of all the sites of gout attacks, the sternoclavicular joint was the most common (n = 4), the others being the costal cartilage (n = 2) and manubriosternal joint (n = 2).…”