1. What are the salient findings at the elbow?
The most striking finding is the presence of a large soft tissue opacity posterior to the elbow. There is a small spur at the posterior surface of the olecranon. Note however there is also an erosion of the dorsal surface of the olecranon. A small calclfication is also noted lateral to the capitulum.
2. What are the salient findings at the right hand? left hand? Do the findings fit a specific pattern?
The right hand demonstrates subtle bony erosive changes at the distal scaphoid and the proximal and distal interphalageal joints. More obvious changes are seen at the first metacarpophalangeal and third distal interphalangeal joints. There are associated soft tissue masses.
The left hand demonstrates erosions at the radial styloid process, distal ulna, scaphoid, trapezium, first metacarpophalangeal, second distal interphalangeal, and third proximal and distal interphalangeal joints. There are associated soft tissue masses at the first metacarpophalangeal, second distal interphalangeal, and third proximal interphalangeal joints.
The pattern does not fit a bilateral symmetric type such as can be seen with rheumatoid arthritis. The location of the erosions do not fit the classic marginal erosions of rheumatoid. The changes can be seen with a deposition arthritis however.
3. What are the salient findings at the knee?
There are degenerative changes at the knee. Closer examination shows multiple oval soft tissue opacities about the knee. The opacities are suggestive of a joint deposition disease.
4. What category of disease does the accumulation of findings suggest? What is your differential diagnosis? Do you have a final diagnosis?
The findings are consistent with an arthropathy, and more specifically, a deposition disease. Differential considerations would include gout, an atypical rheumatoid arthritis, multicentric reticulohistocytosis, amyloidosis, and sarcoidosis.
DIAGNOSIS - GOUT.
Gout is an arthritic disorder related to hyperuricemia and due to deposition of monosodium urate crystals in synovial fluid or connective tissue. Tophaceous deposits in the joints produce erosions, producing a characteristic overhanging edge. The joint space is typically preserved until later stages. The foot, specifically the great toe, is the most common site for gout. The elbows, hands, and feet are other common sites. Spinal involvement, including the intervertebral discs and SI joints, can occur but is rare.
The most striking finding is the presence of a large soft tissue opacity posterior to the elbow. There is a small spur at the posterior surface of the olecranon. Note however there is also an erosion of the dorsal surface of the olecranon. A small calclfication is also noted lateral to the capitulum.
2. What are the salient findings at the right hand? left hand? Do the findings fit a specific pattern?
The right hand demonstrates subtle bony erosive changes at the distal scaphoid and the proximal and distal interphalageal joints. More obvious changes are seen at the first metacarpophalangeal and third distal interphalangeal joints. There are associated soft tissue masses.
The left hand demonstrates erosions at the radial styloid process, distal ulna, scaphoid, trapezium, first metacarpophalangeal, second distal interphalangeal, and third proximal and distal interphalangeal joints. There are associated soft tissue masses at the first metacarpophalangeal, second distal interphalangeal, and third proximal interphalangeal joints.
The pattern does not fit a bilateral symmetric type such as can be seen with rheumatoid arthritis. The location of the erosions do not fit the classic marginal erosions of rheumatoid. The changes can be seen with a deposition arthritis however.
3. What are the salient findings at the knee?
There are degenerative changes at the knee. Closer examination shows multiple oval soft tissue opacities about the knee. The opacities are suggestive of a joint deposition disease.
4. What category of disease does the accumulation of findings suggest? What is your differential diagnosis? Do you have a final diagnosis?
The findings are consistent with an arthropathy, and more specifically, a deposition disease. Differential considerations would include gout, an atypical rheumatoid arthritis, multicentric reticulohistocytosis, amyloidosis, and sarcoidosis.
DIAGNOSIS - GOUT.
Gout is an arthritic disorder related to hyperuricemia and due to deposition of monosodium urate crystals in synovial fluid or connective tissue. Tophaceous deposits in the joints produce erosions, producing a characteristic overhanging edge. The joint space is typically preserved until later stages. The foot, specifically the great toe, is the most common site for gout. The elbows, hands, and feet are other common sites. Spinal involvement, including the intervertebral discs and SI joints, can occur but is rare.