Pseudotumoral tophaceous involvement of the Achilles paratenon

Abstract

A 43-year-old textile worker consulted our hospital with a severalyear history of a painless, slowgrowing ankle mass. He had noticed the mass for the first time approxiConventional lateral radiograph of the left ankle showed a non-specific but well-defined soft-tissue mass in the posterior ankle region without obvious calcifications (Fig. 1A). The mass was located along the expected course of the Achilles tendon. Ultrasound examination clarified a well-defined lesion which was situated adjacent to the Achilles tendon and characteristics of intralesional reflections and retro-acoustic shadowing (Fig. 1B). The mass was noncompressible and no internal calcifications were seen.On MR the mass had a heterogeneous low to intermediate signal intensity pattern on theT2 weighted imaged images ( Fig. 2A), the T1-weighted appearance was consistent, with a homogeneously low to mately 5 years previously as a small lump, painlessly increasing in size over time.The medical history of the patient revealed that he had visited an orthopaedic surgeon 12 months earlier for anterior knee pain which was conservatively treated. Physical examination noted a normal gait. Inspection and palpation showed an obvious, firm and mobile mass situated in the posterior-medial aspect of the ankle and adjacent to the Achilles tendon. It was tender, measuring approximately 2,5 cm. His muscle bulk, strength, reflexes, and sensation were enterily normal. No obvious vascular findings were found. The patient had a normal neurologic status with no Tinel's sign of the sural nerve. , 2015, 98: 34-36. JBR-BTR Pseudotumoral toPhaCeous involvement of the aChilles ParatenonT. Ryckaert, I. Crevits, S. Brijs, G. Debakker, F. Rosseel, A. Tieleman, R. De Man 1 Gout is the most common form of microcrystalline arthropathy which usually does not pose a diagnostic challenge when patients have typical presentation, appropriate biochemical picture and classical radiographic appearance. however, formation of gouty tophi in unusual locations and with atypical presentations may mislead clinicians and radiologists, thereby justifying gout nickname as the "great mimicker". When interpreting images of tendon related masses, radiologists should be aware of gouty tophi as a possible differential given its variable and nonspecific imaging appearance. in this article, we present a case of a patient with a painless tophaceous gout nodule, adjacent to the achilles tendon.

Unusual Gouty Tophi Simulating Malignancy

“…There is limited number of papers reporting gouty tophi that mimics malignancy radiologically. [9][10][11][12][13] The hand and foot lesions in our case had atypical radiographic findings with destructive bone and joint changes simulating a malignancy. Roentgenographic changes in gouty arthropathy are not sufficiently sensitive and specific for the diagnosis.…”

Case Series: Dual-Energy CT in Extra-Articular Manifestations of Gout

“…DECT can also serve as an important diagnostic aid in cases of painful tendon swelling or pseudotumoral involvement of tendons. This way DECT can help in the atypical presentation of gout when solely extra-articular tophus formation is found devoid of any signs of arthritis [3].…”

“…Usually, diagnosis is clear when patients present with typical signs and symptoms of gout. Nevertheless, atypical cases exist and may confront clinicians with diagnostic difficulties [3,4]. In this case series four patients are presented in whom gout was suspected and dual-energy computed tomography (DECT) was used to confirm or exclude the diagnosis.…”