Gouty Tophus in the Foot without Hyperuricemia Diagnosed by Dual-energy Computed Tomography: A Case Report

Abstract

Introduction: Gouty tophi are relatively simple to diagnose because they almost always occur in patients with persistent hyperuricemia. Treatment typically consists mainly of oral medication, and surgical intervention is necessary for only a small number of patients. Case Presentation: We present a case of 66-year-old Japanese man presented with a painful gouty tophus diagnosed by dual-energy computed tomography in the right foot without hyperuricemia that had gradually increased in size over the past 20 years. The tophus was removed and the patient’s plantar pain disappeared after surgery and there was no recurrence. Conclusion: We obtained a favorable outcome through surgical intervention for a gouty tophus of the foot diagnosed by dual-energy computed tomography in a patient without hyperuricemia. Our experience suggests that proactive surgical removal of gouty tophi should be considered for symptomatic cases and to prevent further joint destruction. Keywords:Dual-energy computed tomography, foot, gouty tophus.

Three Cases of Gouty Tophus in the Foot Treated by Resection

“…MRI typically shows a low-to-moderate signal on T1-weighted images and a more variable, moderate-to-high signal on T2-weighted images, which may be difficult to distinguish from malignancy. Recently, dual-energy CT, which uses X-rays with two different levels of energy, has been reported to be useful for discriminating between uric acid crystals and bone and calcified lesions [6,7]. In our third case, it was difficult to detect the gout nodule by MRI, and the diagnosis was made by dual-energy CT.…”