As published by The Radiological Society of New Jersey

The radiograph demonstrates a large tophus at the 1st MTP joint. There are several erosions throughout the foot, which are well corticated, some, of which show overhanging edges. The MRI again demonstrates the erosions and tophus with low T1 signal, heterogenous low to intermediate T2 signal and enhancement on post contrast images.

Diagnosis: Tophaceous Gout
Gout is caused by the deposition of monosodium urate crystals in the joints or soft tissues. The definitive diagnosis requires joint aspiration to show negatively birefringent urate crystals under a polarized light microscope. The peak incidence occurs between 30-50 years of age (males greater than females) with an increasing prevalence with age. The most commonly affected joint is the first metatarsophalangeal joint of the foot, also known as “podagra”. Clinical gout may be divided into 4 different phases: asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout (between acute attacks), and chronic tophaceous gout. Asymptomatic hyperuricemia is common and ordinarily requires no treatment. NSAIDS are used for acute gouty attacks, with corticosteroids and/or colchicine considered for those in whom NSAIDS are contraindicated.

It should be noted that the characteristic radiographic features of gout are usually observed only in the later chronic tophaceous gout stage of the disease. During the early stages, nonspecific features of swelling or a joint effusion may be seen. During the chronic tophaceous stage, polyarticular changes with asymmetric joint involvement occur….

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