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53-year-old male with numerous large tophi along the fingers and wrist

Uric acid deposits

REFERENCE: Nicolaou S, et al. AJR Am J Roentgenol. 2012;199:S78-S86.

53-year-old male with extensive uric acid deposits along the right proximal elbow

Uric acid deposits

REFERENCE: Nicolaou S, et al. AJR Am J Roentgenol. 2012;199:S78-S86.

53-year-old male with gout and large uric acid deposits at the MTP joints, proximal and distal interphalangeal joints, and along the Achilles tendon

Uric acid deposits

REFERENCE: Nicolaou S, et al. AJR Am J Roentgenol. 2012;199:S78-S86.

48-year-old male with gout and extensive uric acid deposits in and around the knee joint

Urate buildup

REFERENCE: Nicolaou S, et al. AJR Am J Roentgenol. 2012;199:S78-S86.

Urate crystal deposits in the left anterior descending artery of the cardiovascular system

Urate crystals

Unpublished image and supporting information used with permission courtesy of Dr. Savvas Nicolaou.

REFERENCE: Data on file. Horizon, February 2019.

A 74-year-old male with gout and monosodium urate (MSU) burden in the feet

MSU crystals

REFERENCES: Nicolaou S, et al. AJR Am J Roentgenol. 2012;199:S78-S86.
Data on file. Horizon, February 2019.

A 74-year-old gout patient’s hands with widespread urate buildup

Urate buildup

Unpublished image and supporting information used with permission courtesy of Dr. Savvas Nicolaou.

REFERENCE: Data on file. Horizon, February 2019.

Knees of a 74-year-old male with monosodium urate (MSU) accumulation

MSU crystals

Unpublished image and supporting information used with permission courtesy of Dr. Savvas Nicolaou.

REFERENCE: Data on file. Horizon, February 2019.

63-year-old female with asymptomatic urate deposition in the right temporomandibular joint

Urate crystals

REFERENCE: Desai MA, et al. RadioGraphics. 2011;31(5):1365-1375.

58-year-old male gout patient with costal cartilage and intervertebral disk uric acid deposition (View 1)

Uric acid deposits

REFERENCE: Carr A, et al. AJR Am J Roentgenol. 2016;206(5):1063-1067.

58-year-old male gout patient with costal cartilage and intervertebral disk uric acid deposition (View 2)

Uric acid deposits

REFERENCE: Carr A, et al. AJR Am J Roentgenol. 2016;206(5):1063-1067.

Uric acid crystals on bone and Achilles tendon of a patient with tophaceous gout

Urate buildup

REFERENCE: Perez-Ruiz F, et al. Adv Ther. 2015;32:31-41.

54-year-old male with chronic tophaceous gout. CT scan reveals cloud-like lesions in lumbar region and erosion of sacroiliac joints

Cloud-like lesions and joint erosion

REFERENCE: Gongidi P, et al. J Radiol Case Rep. 2010;4(5):13-18.

54-year-old male with chronic tophaceous gout. CT scan reveals soft-tissue mass and an associated fracture on the right posterior 10th rib

Tophus and associated fracture

REFERENCE: Gongidi P, et al. J Radiol Case Rep. 2010;4(5):13-18.

54-year-old male with chronic tophaceous gout. X-ray of the knee reveals periarticular erosions, severe joint space narrowing, and urate deposition

Tophaceous deposition, joint space narrowing, and erosion

REFERENCE: Gongidi P, et al. J Radiol Case Rep. 2010;4(5):13-18.

Patient with known tophaceous gout. Anteroposterior x-ray shows a mineralized tophus and periarticular “rat bite” erosions of the index finger

Tophus and associated erosion

REFERENCE: Desai MA, et al. RadioGraphics. 2011;31(5):1365-1375.

X-rays of gout-affected first metatarsophalangeal joints from 3 different patients showing erosion

Erosion

REFERENCE: Dalbeth N, et al. Ann Rheum Dis. 2015;74:1030-1036.

X-ray of a 66-year-old male with hyperuricemia and a suspected tophus resulting in morphologic damage to the left mandibular condyle

Morphologic change

REFERENCE: Oliveira INF, et al. Int Arch Otorhinolaryngol. 2014;18(3):316-318.

Axial CT of a 73-year-old male revealing a cystic mass on the anterior chest wall with large quantities of monosodium urate (MSU) crystals

MSU-enriched mass

REFERENCE: Wolfenden T, et al. BMJ Case Rep. [published online April 11, 2014]. doi:10.1136/bcr-2013-203294.

Coronal CT of a 67-year-old male showing an incidental hypodense lesion found to have monosodium urate crystals by needle aspiration. The lesion resolved with an increased allopurinol dose

Uric acid lesion

REFERENCE: Koh H, et al. BMJ Case Rep. [published online May 17, 2016]. doi:10.1136/bcr-2016-215449.

CT scan of the lumbar spine in a 60-year-old male with history of gout showing a tophaceous mass, vertebral arch, and facet joint erosion

Tophus and associated erosion

REFERENCE: Zhang H, et al. Int J Clin Exp Med. 2017;10(3):5493-5496.

Axial CT of a 77-year-old female patient with high uric acid levels displaying a rare spinal tophus with associated erosion and calcification

Tophus and associated erosion

REFERENCE: Hasturk A, et al. Eur Spine J. 2012;21(Suppl 4):S400-S403.

Axial CT of a 73-year-old female with past history of tophaceous gout, displaying a soft tissue mass. Biopsy determined lesion to be monosodium urate-positive and chalky

Tophus

REFERENCE: Gardner H, et al. Ann Rheum Dis. 2004;63(7):767-768.

X-rays depicting tophus-induced cortical erosion and symphysis widening in a 73-year-old female. Top x-ray was taken 12 years prior to the bottom x-ray

Cortical erosion and symphysis widening

REFERENCE: Gardner H, et al. Ann Rheum Dis. 2004;63(7):767-768.

X-ray of a 43-year-old male with knee pain displaying a large intraosseous tophus

Large tophus

REFERENCE: Llauger J, et al. RadioGraphics. 2000;20:S263-S278.

Long-axis ultrasound of a 66-year-old male gout patient’s lateral knee. Image shows bone erosion and tophi involving surrounding connective tissues

Tophus

Erosion

REFERENCE: Girish G, et al. AJR Am Roentgenol. 2013;201(3):515-525.

Sagittal MRI of a 56-year-old male gout patient’s foot. MRI shows erosions of the tarsal bones and multiple tophi

Tophus and erosion

REFERENCE: Girish G, et al. AJR Am Roentgenol. 2013;201(3):515-525.

Sagittal MRI of a 64-year-old male gout patient’s knee. Scan revealed tophi involving the cruciate ligaments

Tophus

REFERENCE: Girish G, et al. AJR Am Roentgenol. 2013;201(3):515-525.

MRI of a 53-year-old male’s liver displaying alcoholic cirrhosis and an atypical nodule. Nodule was later confirmed to be a gouty tophus

Tophus

REFERENCE: Varinot J, et al. Clin Res Hepatol Gastroenterol. 2011;35(12):855-856.

PET/MRI fusion image of the spine of a 36-year-old female patient with tophaceous gout. Image shows hypermetabolic activity corresponding to tophi mass lesions

Lesions

REFERENCE: Popovich T, et al. AJNR Am J Neuroradiol. 2006;27(6):1201-1203.

Axial MRI of a 69-year-old female gout patient’s sacroiliac joints. Scan reveals bilateral bone erosions

Erosion

REFERENCE: Cardoso FN, et al. Acta Radiol Short Rep. 2014;3(8):1-5.

MRI of a 60-year-old male gout patient’s lumbar spine. L4 and L5 laminal damage was caused by a mass later determined to be tophaceous and chalky

Tophaceous mass and L4/L5 damage

REFERENCE: Zhang H, et al. Int J Clin Exp Med. 2017;10(3):5493-5496.

Transverse MRI of the wrist showing a tophus and associated erosion

Tophus and erosion

REFERENCE: Chowalloor PV, et al. Ther Adv Musculoskel Dis. 2014;6(4):131-143.

MRI of the cervical spine showing erosion of the odontoid peg in a patient with gout

Erosion

REFERENCE: Chowalloor PV, et al. Ther Adv Musculoskel Dis. 2014;6(4):131-143.

Ultrasound of an interphalangeal joint in a gout patient’s ring finger. Urate crystal deposition was suspected due to hyperechoic spots and joint effusion

Suspected tophus and effusion

REFERENCE: Chowalloor PV, et al. Ther Adv Musculoskel Dis. 2014;6(4):131-143.

Longitudinal ultrasound of a gout patient’s ankle. Image shows double contour sign from urate deposition atop the talar cartilage

Monosodium urate deposition

REFERENCE: Chowalloor PV, et al. Ther Adv Musculoskel Dis. 2014;6(4):131-143.

Axial MRI of the first metatarsophalangeal joint of a patient with gout

Tophus

REFERENCE: Teh J, et al. Semin Musculoskelet Radiol. 2018;22(2):225-236.

MRI of the temporomandibular joint showing heterogenous lesions. Pathology determined lesions to be gouty tophi

Tophus

REFERENCE: Guerlain J, et al. J Rheumatol. 2015;42(7):1261-1262.

Photograph of urate deposits in a gout patient’s quadricep tendon

Urate deposits

REFERENCE: Desai MA, et al. Radiographics. 2011;31(5):1365-1375.

Pathology of a spinal biopsy from a 36-year-old female gout patient. Biopsy revealed urate crystals with strong negative birefringence

REFERENCE: Popovich T, et al. AJNR Am J Neuroradiol. 2006;27(6):1201-1203.

Pathology of a spinal biopsy from a 36-year-old female gout patient. Image shows eroded bone due to surrounding gouty tophi

REFERENCE: Popovich T, et al. AJNR Am J Neuroradiol. 2006;27(6):1201-1203.

56-year-old male patient with gout. Photograph of a rare tophus mass in the right lower lobe bronchus of the lung

REFERENCE: Adamson R, et al. Am J Respir Crit Care Med. 2013;188(12):e72-e73.

Photomicrograph depicting urate crystals with strong negative birefringence from a rare lung tophus in a 56-year-old male gout patient

REFERENCE: Adamson R, et al. Am J Respir Crit Care Med. 2013;188(12):e72-e73.

Compensated polarized light microscopy of a tophus in a 77-year-old male gout patient’s cuticle. Image shows abundant monosodium urate crystals

REFERENCE: Vela P, et al. N Engl J Med. 2015;372(5):e6.

Excision of a 31-year-old male gout patient’s elbow mass, which contained chalk-like urate crystals

REFERENCE: Dorsey ML, et al. Radiol Case Rep. 2006;1(4):140-144.

Low (left) and high (right) power magnification H&E stains of a tophus in a 31-year-old male gout patient’s elbow. Images show multinucleated giant cells and inflammation

REFERENCE: Dorsey ML, et al. Radiol Case Rep. 2006;1(4):140-144.

Chalky, white, gouty deposits from a 65-year-old male gout patient’s knee

REFERENCE: Mittl GS, et al. Bull Hosp Jt Dis. 2015;73(3):210-212.

35-year-old male patient with gouty arthritis. Pictures depict nodules of cutaneous tophi on the forearm (left) and shoulder (right)

REFERENCE: Lo TE, et al. BMJ Case Rep. [published online July 10, 2013]. doi:10.1136/bcr-2013-009735.

73-year-old male patient with polyarticular gout and a cystic, monosodium urate-positive mass on the anterior chest wall

Monosodium urate-positive mass

REFERENCE: Wolfenden TP, et al. BMJ Case Rep. [published online April 11, 2014]. doi:10.1136/bcr-2013-203294.

Male patient with a 12-year history of gout. Photograph shows chalky, white crystals in the nasal superficial sclera of the right eye

Uric acid crystals

REFERENCE: Lin J, et al. Int J Ophthalmol. 2013;6(3):307-311.

H&E-stained biopsy of a rare tophus in the costochondral junction of the heart from a 49-year-old male after a heart transplant. H&E shows fibrous tissue and foreign-body giant cells

REFERENCE: Chang PC, et al. Skeletal Radiol. 2006;35(9):684-686.

Polarizing microscopy (left) and deconvolution confocal microscopy (right) of the same cells/tophus. Tophus was uncommonly located in the left anterior artery

Intracellular birefringent crystals

REFERENCE: Park JJ, et al. BMJ Open. 2014;4(7):e005308.

77-year-old male gout patient with subcutaneous gouty tophi on toes

REFERENCE: Pawar MK. Eur J Rheumatol. 2018;5(2):149-150.

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