The following ankle x-rays are from a 77 year old male with right ankle swelling and pain who has a history of hypertension. What can you see?[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]
The ankle x-rays show a well defined, punched out lucency on the medial aspect of the lateral malleolus with a sclerotic margin. The joint space is narrowed with osteophytic lipping and there is soft tissue swelling around the ankle joint.
The most likely diagnosis of the x-ray appearance is gout. This patient had elevated uric acid levels and a past history of gout. He was treated for acute attack of gout and responded well.
Punched out lesion in gout is due to erosion from long standing soft tissue tophus. Gout deposits around the joint can be intra-articular, subchondral or juxta-articular.
In rheumatoid arthritis, which commonly involves small joints symmetrically, marginal bony erosions will not have sclerotic margins and there will be juxta-articular osteoporosis.[/peekaboo_content]