Imaging Case of the Week 92

The following left hand x-ray is from a 70 year old woman experiencing pain and swelling in the left index finger. What can be seen?

left hand x-ray

click to enlarge

[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The x-ray shows abnormality around the distal IP joint of the index finger and there are well-defined punched out, periarticular erosions with overhanging margins. There is a surrounding soft tissue swelling which is compatible with a tophus. These findings are consistent with a tophaceous gout.

DIP joint gout

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Causes of distal IP joint arthritis are:

  • Osteoarthritis
  • Gout
  • Psoriatic arthritis

In contrast, rheumatoid arthritis involves the PIP joint.