Tophus Causing Bronchial Obstruction

Adamson, Rosemary; Lacy, John M.; Cheng, Aaron M.; Park, David R.

doi:10.1164/rccm.201301-0097im

Cited by 7 publications

(4 citation statements)

References 2 publications

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“…This includes atypical musculoskeletal presentations causing spinal cord or nerve root compression [16][17][18] or involving the tarsal tunnel [19], the patellar tendon [20,21], the second metacarpal [22] and the os trigonum [23]. Additionally, non-skeletal presentations may rarely occur, including in the bronchus, causing airways obstruction [24], the mitral valve [25], the liver [26] and the breast [27].…”

Section: Clinical Presentation Of Tophaceous Goutmentioning

confidence: 99%

The Gouty Tophus: a Review

2015

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The tophus is the cardinal feature of advanced gout. This review summarises recent research into the biology, impact and treatment of tophaceous gout. Microscopically, tophi are chronic foreign body granuloma-like structures containing collections of monosodium urate (MSU) crystals surrounded by inflammatory cells and connective tissue. Extracellular trap formation mediated by neutrophil interactions with MSU crystals may be a central checkpoint in tophus formation. Gouty tophi impact on many aspects of health-related quality of life. Tophi are also implicated in the development of structural joint damage and increased mortality risk in people with gout. Effective treatment of tophaceous gout requires long-term urate-lowering therapy, ideally to achieve a serum urate concentration of <5 mg/dL (300 μmol/L). Recent advances in gout therapeutics have expanded urate-lowering therapy options for patients with severe tophaceous disease to allow faster regression of tophi, improved health-related quality of life and, potentially, improved structural outcomes.

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Section: Clinical Presentation Of Tophaceous Goutmentioning

confidence: 99%

The Gouty Tophus: a Review

2015

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“…Five cases in the literature described mammary gout which presented as non-specific masses on mammography and biopsy proven to be tophi [ 93 ] ( Table 1 ). Four articles reported urate deposition within the pulmonary system through histopathology and imaging ( Table 1 ) including tophi presenting as lung nodules and an endobronchial mass ( Figure 7 A,B) [ 94 ]. In one patient, uric acid crystals were found in pleural effusions upon aspiration [ 95 ].…”

Section: Resultsmentioning

confidence: 99%

“…Readers are encouraged to read the entire article for the correct context at doi: 10.1164/rccm.201301-0097IM. The authors, editors, and The American Thoracic Society are not responsible for errors or omissions in adaptations [ 94 ].…”

Section: Figurementioning

confidence: 99%

Systemic Urate Deposition: An Unrecognized Complication of Gout?

Khanna

Johnson

Marder

et al. 2020

JCM

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Gout, an inflammatory arthritis, affects over nine million people in the US with increasing prevalence. Some medical societies do not recommend treating gout unless it is recurrent. While soft tissue urate deposits (tophi), resultant bone erosions, and joint inflammation are frequently recognized in gout, urate crystal deposits in other sites have been thought to be rare. Recent diagnostic testing, such as dual energy computed tomography (DECT), has led to the recognition that urate deposits are not uncommon in other tissues including the vasculature. To understand the potential risks for untreated gout, we reviewed the literature on extra-articular urate deposition documented by autopsy, histopathology, surgery, and radiology, including the heart, blood vessels, kidney, spine, eye, skin, and gastrointestinal system. These studies extend the significance of gout beyond the rheumatologist and emphasize the need for physicians to follow the American College of Rheumatology guidelines to treat subjects with gout to a goal of achieving serum urate <6 mg/dl. Given the growing body of literature on extraarticular urate deposition, further studies and clinical trials are needed to determine the clinical consequences of systemic urate deposition, including if reducing cardiac and vascular urate deposits may provide a survival benefit for this at-risk population.

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“…These include atypical musculoskeletal presentations causing spinal cord or nerve root compression [ 10 - 11 ], or involving the tarsal tunnel [ 12 ], patellar tendon [ 13 ], second metacarpal [ 14 ], or os trigonum [ 15 ]. Additionally, tophi have been reported outside of the musculoskeletal system, in the bronchus [ 16 ], mitral valve [ 17 ], liver [ 18 ], and breast [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of a Second Intermetatarsal Space Gouty Tophus with a Presentation Similar to a Morton’s Neuroma

Razaghi

Abyar

Cignetti

et al. 2018

Cureus

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Non-infectious soft tissue lesions of the foot and ankle are relatively rare clinically. These include benign and malignant neoplasms, as well as non-neoplastic or pseudotumoral lesions such as ganglionic, synovial and epidermoid cysts, intermetatarsal and adventitious bursitis, inflammatory lesions like gouty tophi and rheumatoid nodules, Morton’s neuroma, and granuloma annulare.A 48-year-old male with a history of medically treated tophaceous gout presented with left foot neuropathic pain and paresthesia, in the setting of a well-circumscribed soft tissue lesion of the second intermetatarsal space, suspected to be a Morton’s neuroma. Magnetic resonance imaging (MRI) showed a 4.1 x 2.7 x 2.6 cm heterogeneous soft tissue mass containing multiple cystic areas. Excisional biopsy was performed and histologic examination revealed well-circumscribed nodules of amorphous material containing needle-shaped clefts, rimmed by histiocytes, and multinucleated giant cells consistent with a gouty tophus.This is the first case reported in the literature of an intermetatarsal gouty tophus causing neuropathic pain and paresthesia. While Morton’s neuroma is the most common cause of this presentation, this case illustrates that other pseudotumoral lesions, such as a gouty tophus, may present similarly, and should be considered in the differential diagnosis. While most cases of tophaceous gout can be adequately treated with urate-lowering therapy, surgery may be indicated for tophi that do not resolve with medical treatment based upon symptom severity, compression of nearby structures, and functional impairment.

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Tophus Causing Bronchial Obstruction

Cited by 7 publications

References 2 publications

The Gouty Tophus: a Review

The Gouty Tophus: a Review

Systemic Urate Deposition: An Unrecognized Complication of Gout?

A Case of a Second Intermetatarsal Space Gouty Tophus with a Presentation Similar to a Morton’s Neuroma

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