Reason: 77 yo diabetic heart and kidney transplant recipient with gout and diabetes; has persistent left 5th finger swelling/pain with x-ray showing osteolysis-osteomyelitis vs tophaceous gout History: Pain, swelling of left 5th digit of hand; no improvement with prednisone. There is a mass replacing the majority of the middle phalanx of the fifth finger with sparing of its base as well as within the proximal half of the distal phalanx. The tuft of the distal phalanx appears spared, although there is marrow edema within the tuft on fluid sensitive sequences. The mass extends into the soft tissues predominantly along the dorsal and medial aspects of the bones. There is mild edema within the surrounding subcutaneous fat as well as mild thickening of the skin. While it is impossible to exclude infection, these findings are compatible with tophaceous gout. There are small foci of signal abnormality within the third metacarpal head in multiple carpal bones that may represent cysts or small chronic erosions. Although the wrist is not included in its entirety, there is increased signal intensity within the midcarpal joint which may represent a small amount of fluid or a mild synovitis. There is minimal fluid seen within the tendon sheaths of the flexor tendons which is probably of no clinical significance.
Tophaceous gout involving the distal and middle phalanges of the fifth finger. While it is impossible to exclude a superimposed infection, the findings may certainly be due solely to gout.