Second and third finger pain and swelling, clinical diagnosis of gout There is a soft tissue mass surrounding the DIP joint of the index finger that is predominantly isointense to skeletal muscle on T1 sequences and heterogeneous but predominantly hyperintense on T2 sequences which demonstrates diffuse and slightly heterogeneous enhancement following gadolinium administration. The mass results in erosion of the base of the distal phalanx and head of the middle phalanx with adjacent marrow edema and enhancement of the medial bone. The flexor digitorum profundus appears to insert on the base of the distal phalanx. The terminal extensor tendon is thinned distally and is suspected to be partially torn although a portion of the tendon appears attached to the bone. At the level of the DIP joint, the extensor tendon is displaced dorsally by the mass. The collateral ligaments at this joint are difficult to discern and may be torn.A similar but slightly less extensive mass surrounds the PIP joint of the middle finger with erosion of the base of the middle phalanx and small erosions of the head of the proximal phalanx. This mass extends into the subcutaneous fat dorsal to the extensor apparatus. There is perhaps slight volar displacement of the flexor apparatus although the tendons appear intact. The central slip of the extensor tendon attaches to the base of the middle phalanx. We suspect the collateral ligaments are intact.There is a 2 mm enhancing nodule within the soft tissues adjacent to the flexor tendon apparatus of the fifth finger near the base of the proximal phalanx. There is mild synovitis of the first MCP joint which contains small erosions. Small foci of nonenhancing signal abnormality are identified within the heads of the third and fifth metacarpals which likely represent cysts. The remaining bones and soft tissues of the hand are unremarkable.
Finger masses as described above with erosions of the DIP joint of the index finger and PIP joint of the middle finger. While it is impossible to completely exclude a superimposed infection, these findings are compatible with gout.