Dual-energy Computed Tomography for Diagnosis of Gouty Tophus of Tibia with Pathological Fracture Simulating Malignancy

Full Article

CYH Chan, KWK Tsang, KC Lai, MK Chan

Hong Kong J Radiol 2017;20:59-63

DOI: 10.12809/hkjr1715374

Gouty tophus with pathological fracture is rare and can mimic infection and malignancy. We report the first case of intra-osseous tophus of the tibia complicated by pathological fracture. Although rare, intra-osseous gouty tophus can present with pathological fracture and thus should always be considered in the presence of collateral evidence. Dual-energy computed tomography (DECT) is highly accurate in detecting intra-articular and peri-articular monosodium urate in gout. In our patient, DECT clearly depicted both intra-articular and peri-articular monosodium urate depositions. Nonetheless, this imaging technique is not without pitfalls. As illustrated in our patient, the intra-osseous component is wrongly shown as being monosodium urate free. We postulate that the intra-osseous location may be a potential pitfall of DECT. Radiologists and clinicians should keep this in mind during image interpretation.


Authors’ affiliation:
CYH Chan, KWK Tsang, KC Lai, MK Chan: Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong