Lumbar Gout Tophus Mimicking Epidural Abscess with Magnetic Resonance Imaging, Bone, and Gallium Scans

Vicente, J. Serrano; Gómez, A. Golpe; Moreno, Rafael Lorente; Torre, J.R. Infante de la; Bernardo, Lucía García; Madrid, J.I. Rayo

doi:10.4103/ijnm.ijnm_139_17

Cited by 5 publications

(6 citation statements)

References 5 publications

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“…To our knowledge, only a few case reports have described the use of SPECT/CT to evaluate gout tophi. 3 – 6 In these reports, anomalous increases in [ 99m Tc]-MDP were reported in tophi; these increases were presumably the result of inflammation, which led to greater blood supply in the region. Furthermore, tophi can cause bone erosion and remodeling.…”

Section: Discussionmentioning

confidence: 98%

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^99mTc-methylene diphosphonate SPECT/CT imaging of gout spondylitis: a case report

et al. 2022

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Single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging of the gouty spine is rare. We describe a 66-year-old man who presented with pain and numbness in the right lower leg; he reported a 2-month history of intermittent low back pain. Imaging revealed neoplastic lesions of the spine, which were initially regarded as tumors. Thus, the patient underwent surgical removal of the lumbar lesion. However, the postoperative pathological diagnosis was gout spondylitis. In this report, we show multimodal images of advanced gout spondylitis. The metabolic information provided by SPECT/CT, combined with the microscopic changes in bone structure revealed by dual-source thin-layer CT and the anatomical localization information provided by magnetic resonance imaging, can help clinicians to more fully understand the pathophysiological mechanisms and imaging manifestations of gout from multiple perspectives, thereby reducing the rate of misdiagnosis.

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Section: Discussionmentioning

confidence: 98%

“…To our knowledge, there have been few reports concerning the use of [ 99m Tc]-methylene diphosphonate (MDP) single-photon emission computed tomography (SPECT)/CT imaging to assess spinal tophi. [3][4][5][6] Here, we discuss the usefulness of [ 99m Tc]-MDP SPECT/CT imaging in the diagnosis of gout spondylitis.…”

Section: Introductionmentioning

confidence: 99%

^99mTc-methylene diphosphonate SPECT/CT imaging of gout spondylitis: a case report

et al. 2022

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Section: Discussionmentioning

confidence: 99%

“…Usually, this pattern of intraspinal gout tophus is confused with other spinal canal space-occupying lesions, such as abscess, disc migration, neoplasms, hematoma, and synovial cysts. [3,7,8] In the initial care plan, routine radiography is appropriate and cost-effective. Although this preliminary screening tool lacks sensitivity, [9] it can identify lumbar instability associated with calcified gout.…”

Section: Discussionmentioning

confidence: 99%

Intraspinal extradural gout tophus in the lumbar vertebral canal

Wú

Liu²,

Dai³

et al. 2022

Medicine

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Rationale: Intraspinal gout tophus in the lumbar vertebral canal associated with gouty arthritis is rare. We present 2 cases with the first manifestations of a sequestrated intervertebral disc and an extradural tumor, and histopathologically proven to be gouty deposits in the lumbar vertebral canal. Patient concerns: The 2 patients presented with typical radiculopathy symptoms and a positive straight leg raise. In 1 case, there was weakness of the left toe extensors, with a positive left femoral nerve traction test. Additionally, the left patellar tendon reflex was weak. In the other patient who was unable to walk, there was a sensory deficit in the saddle distribution. Diagnosis: Histopathological examination of the specimens taken from the operation confirmed the presence of gouty deposits. Interventions: Posterior decompression was performed in these 2 cases, and chalky-white materials were identified in the lumbar vertebral canal. Outcomes: No evidence of neoplasm, infection, or synovial cyst was found. Lessons: Definitive diagnosis of intraspinal extradural gout tophus, mimicking a sequestrated intervertebral disc or an extradural tumor, may be difficult. The initial suspicion of intraspinal gouty deposits, based on the diagnostic/management algorithm, may effectively avoid incorrect diagnosis via a less invasive procedure than explorative laminectomy.

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“…Gouty tophus has been shown to be moderately hypermetabolic on fluorodeoxyglucose positron emission tomography CT (FDG PET CT) [ 85 , 86 , 87 ]. Tophaceous gout in the spine will show uptake on Gallium-67 imaging [ 88 ].…”

Section: Imagingmentioning

confidence: 99%

Gouty Arthropathy: Review of Clinical Manifestations and Treatment, with Emphasis on Imaging

Weaver

Vina

Munk

et al. 2021

JCM

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Gout, a crystalline arthropathy caused by the deposition of monosodium urate crystals in the articular and periarticular soft tissues, is a frequent cause of painful arthropathy. Imaging has an important role in the initial evaluation as well as the treatment and follow up of gouty arthropathy. The imaging findings of gouty arthropathy on radiography, ultrasonography, computed tomography, dual energy computed tomography, and magnetic resonance imaging are described to include findings of the early, acute and chronic phases of gout. These findings include early monosodium urate deposits, osseous erosions, and tophi, which may involve periarticular tissues, tendons, and bursae. Treatment of gout includes non-steroidal anti-inflammatories, colchicine, glucocorticoids, interleukin-1 inhibitors, xanthine oxidase inhibitors, uricosuric drugs, and recombinant uricase. Imaging is critical in monitoring response to therapy; clinical management can be modulated based on imaging findings. This review article describes the current standard of care in imaging and treatment of gouty arthropathy.

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Lumbar Gout Tophus Mimicking Epidural Abscess with Magnetic Resonance Imaging, Bone, and Gallium Scans

Cited by 5 publications

References 5 publications

^99mTc-methylene diphosphonate SPECT/CT imaging of gout spondylitis: a case report

^99mTc-methylene diphosphonate SPECT/CT imaging of gout spondylitis: a case report

Intraspinal extradural gout tophus in the lumbar vertebral canal

Gouty Arthropathy: Review of Clinical Manifestations and Treatment, with Emphasis on Imaging

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