Tophaceous Gout, Hand

53-year-old male with chronic pain, warmth, and swelling at the carpus, metacarpophalangeal, and interphalangeal joints of the right hand. The coronal T1 weighted images demonstrate circumscribed, T1 hypointense, soft tissue deposits with lobular margins most prominent at the radial aspect of the distal interphalangeal joint of the index finger where there are associated erosions along the cortical margins. There is additional involvement of the proximal interphalangeal joints of the index and long fingers as well as the metacarpophalangeal joint. The lesions are on the T2 and T1 axial images with heterogeneous enhancement. On radiography, numerous soft tissue calcific deposits are identified the sites with associated marginal osseous erosions. This is a case of tophaceous gout of of the hand. Gout falls in the classification of crystal arthropathy which includes other diseases such as calcium pyrophosphate, calcium oxalate, cholesterol, xanthine and cysteine deposition diseases. There is deposition of monosodium urate crystals both within and around joints. Typical cases arise in the greater than 40 years old with a strong male predilection.