Ultrasound features of tophi in chronic tophaceous gout

• Published in: Skeletal radiology Vol. 40; no. 3; pp. 309 - 315
• Main Authors: de Ávila Fernandes, Eloy, Kubota, Edson S., Sandim, Gabriel B., Mitraud, Sônia A. V., Ferrari, Antonio J. L., Fernandes, Artur R. C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.03.2011; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Biological and medical sciences; Chronic Disease; Diseases of the osteoarticular system; Female; Gout; Gout - diagnostic imaging; Humans; Imaging; Inflammatory joint diseases; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Nuclear Medicine; Orthopedics; Osteoarticular system. Muscles; Pathology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiology; Reproducibility of Results; Scientific Article; Sensitivity and Specificity; Ultrasonography - methods; Hyperuricemia; Diagnosis; Ultrasound; Joints; Gout; Nuclear medicine; Skin disease; Diseases of the osteoarticular system; Metabolic diseases; Uric acid; Joint; Microcristalline arthropathy; Chronic; Orthopedics; Tophus; Purine; Microcrystal
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-010-1008-z

Objective To describe the different and lesser-known ultrasound features of tophi in chronic tophaceous gout. Methods Ultrasound images of 138 affected areas were analyzed from 31 patients with gout, using high-quality broadband linear transducers (frequency range of 8–14 MHz). Tophi were classified relative to echogenicity, echotexture, contours, number and the presence or absence of hypoechoic halo. The duration of illness was correlated with the presence of calcifications in tophi. Results Hyperechoic tophi were seen in 133 areas (96.3%); these were most frequently hyperechoic and heterogeneous (37.6%) or hyperechoic and heterogeneous with calcification (32.6%). Contours were found to be poorly defined in 115 (83.3%) areas. Multiple grouped tophi were seen in 85 areas (61.6%) and 50 areas (36.2%) had individual tophi. In 77 examined areas (55.8%), there was a hypoechoic halo around the tophi. There was no correlation between illness duration and presence of calcifications on tophi. Conclusions Tophi are generally hyperechoic, heterogeneous, with poorly defined contours, multiple grouped and surrounded by an anechoic halo. Individual tophus and the absence of association between illness duration and the presence of calcification are newly described features. This study of tophaceous gout by ultrasound may contribute to the diagnostic elucidation of patients with clinically atypical gout and show its diverse characteristic forms of presentation.