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Imaging

Gout

Preliminary Diagnosis: Gout I. What imaging technique is first-line for this diagnosis? Plain radiographs II. Describe the advantages and disadvantages of this technique for diagnosis of gout. Advantages Clearly visualizes dense gouty tophi and osseous erosions Clearly visualizes overhanging cortical edges and juxtaarticular erosions extending perpendicularly from the underlying bone Disadvantages Radiographs often normal in…
Hospital Medicine

Pseudogout

I. What every physician needs to know. Calcium pyrophosphate dihydrate (CPPD) deposition can be asymptomatic or, alternatively, may present in a number of ways. Pseudogout, which affects approximately 25% of people with CPPD deposition disease, is one such manifestation of CPPD. This chapter will not discuss CPPD in its entirety but rather will focus on…
Hospital Medicine

Gout

I. What every physician needs to know. Gout is a rheumatologic disorder characterized by supersaturation of uric acid in the serum (hyperuricemia) accompanied by attacks of acute, markedly painful monoarticular or polyarticular joint inflammation. Humans lack the enzyme uricase (breaks down uric acid into allantoin); consequently, our serum uric acid levels are close to the…
Dermatology

Gout (Monosodium Urate Deposition Disease)

Are You Confident of the Diagnosis? What you should be alert for in the history The classical presentation of gout (also called podagra) is monoarthritis affecting the first metatarsophalangeal (MTP) joint that , often awakens the patient in the middle of the night. Gout can occur as a monoarthritis, oligoarthritis, or a polyarthritis. The areas…
Imaging

Pseudogout

Preliminary Diagnosis: Pseudogout I. What imaging technique is first-line for this diagnosis? Plain radiography. II. Describe the advantages and disadvantages of this technique for diagnosing pseudogout. Advantages Relatively inexpensive and fast imaging modality. Offers exquisite visualization of focal areas of mineralization noted in pseudogout, predominantly calcium pyrophosphate deposition disease. Highly portable imaging modality. Disadvantages Limited…
Imaging

Gout

Does this patient have Gout? Gout is a disease resulting from deposition of monosodium urate (MSU) crystals in the joints and connective soft-tissues in the setting of sustained hyperuricemia (serum uric acid >6.8 mg/dL). Classically, the initial manifestation of gout is acute monoarthritis characterized with abrupt onset of exquisite pain and swelling of the joint…
Dermatology

Pseudogout (Calcium Phyrophosphate Deposition Disease)

Are You Confident of the Diagnosis? Pseudogout refers to the clinical entity of acute joint inflammation that occurs because of an inflammatory response to deposited calcium-containing crystals. The term chondrocalcinosis refers to deposition of these crystals within the articular cartilage (Figure 1). The most common crystal causing this is calcium pyrophosphate dihydrate (CPPD). Most joints…
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