The following ankle x-rays are from a 60 year old man who has presented with right ankle pain and swelling. He denies any history of trauma. What can you see?

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The lateral view shows a focal bulging density in the anterior talar recess, giving rise to an ankle teardrop sign; this indicates an effusion in the ankle joint. The density extends anteriorly from the ankle joint to the neck of the talus. This sign is said to be useful in the diagnosis of ankle effusions with 5 ml or larger volume.

A less well defined part of effusion is also seen in the posterior recess – there is no irregularity or destruction of the articular surface of ankle.

This patient underwent ankle joint aspiration for a suspected septic arthritis which turned out to be gout.

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