
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Unpublished image and supporting information used with permission courtesy of Dr.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Unpublished image and supporting information used with permission courtesy of Dr.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Unpublished image and supporting information used with permission courtesy of Dr.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
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
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
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
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
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
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
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
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
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
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
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
REFERENCE: Guerlain J, et al. J Rheumatol. 2015;42(7):1261-1262.

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