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High levels of uric acid cause accumulation of monosodium urate crystals. This formation of masses is called tophus. Intraosseous tophus deposits are rare, even for patients with gout. We report an unusual case of intraosseous tophus deposits in the os trigonum. The patient presented with ankle pain with no previous history of gout. On examination, tenderness on the posterior aspect of his ankle and limitation of plantarflexion was noted. Laboratory values were normal, except for an elevated serum uric acid value. Radiographs of the right ankle showed the presence of a large os trigonum with osteosclerotic changes, whereas magnetic resonance imaging showed intraosseous tophus deposits in the os trigonum. Conservative therapy failed, and the patient was admitted for an endoscopic resection of the os trigonum.Intraosseous chalky crystals were detected during endoscopic resection of the os trigonum. The histological diagnosis was tophaceous gout. The underlying pathological mechanism of intraosseous tophi is uncertain. Penetration of urate crystals from the joint due to hyperuricemia may be the mechanism of deposition in this patient.When a patient with hyperuricemia presents with posterior ankle impingement symptoms, intraosseous tophus deposits should be included in the differential diagnosis. Posterior endoscopic excision may be an option for treating intraosseous lesions of the os trigonum because of good visualization, satisfactory excision, and rapid recovery time.
This article was published in the following journal.
To determine the relationship between tophus, erosion and bone remodeling factors in gout.
Paramedics and hospital-based providers occasionally need to place intraosseous devices to obtain vascular access in critically ill patients. Diagnostic radiologists must be prepared for the emergent ...
Impingement following arthroscopic ankle arthrodesis has not been reported in the literature previously. We present a case report of a 68-year-old male 9 months following an uncomplicated arthroscopic...
On-scene invasive emergency procedures, such as intraosseous puncture, are often unavoidable, when indicated, and present a challenge for the emergency physician. Personal, temporal or local condition...
Ulceration over tophi in patients with gout usually causes a number of clinical problems. The aim of this study was to investigate the risk factors for ulceration of tophi in patients with gout. Patie...
The investigators sought to compare the intraosseous access success rates of the proximal tibia and the proximal humerus using new Intraosseous access device "NIO" in an adult cadaver mode...
The investigators will compare the success rates and time to successful IO access during simulated adult resuscitation.
In this trial the investigators seek to determine if injecting cord blood cells directly into the bone marrow (intraosseous injection), rather than infusing them intravenously, can improve...
Direct Skeletal Fixation of Prosthetic Limbs Following Trans-Femoral Amputation - Study of an Intraosseous Transcutaneous Amputation Prosthesis (ITAPTM).
Multicenter randomized study to compare powered intraosseous access to standard central line access for the administration of fluids and drugs for patients in the Emergency Dept.
The administration of medication or fluid through a needle directly into the bone marrow. The technique is especially useful in the management of pediatric emergencies when intravenous access to the systemic circulation is difficult.
A chronic form of glomerulonephritis characterized by deposits of predominantly IMMUNOGLOBULIN A in the mesangial area (GLOMERULAR MESANGIUM). Deposits of COMPLEMENT C3 and IMMUNOGLOBULIN G are also often found. Clinical features may progress from asymptomatic HEMATURIA to END-STAGE KIDNEY DISEASE.
A group of sporadic, familial and/or inherited, degenerative, and infectious disease processes, linked by the common theme of abnormal protein folding and deposition of AMYLOID. As the amyloid deposits enlarge they displace normal tissue structures, causing disruption of function. Various signs and symptoms depend on the location and size of the deposits.
A type of glomerulonephritis that is characterized by the accumulation of immune deposits (COMPLEMENT MEMBRANE ATTACK COMPLEX) on the outer aspect of the GLOMERULAR BASEMENT MEMBRANE. It progresses from subepithelial dense deposits, to basement membrane reaction and eventual thickening of the basement membrane.
Deposits of ADIPOSE TISSUE throughout the body. The pattern of fat deposits in the body regions is an indicator of health status. Excess ABDOMINAL FAT increases health risks more than excess fat around the hips or thighs, therefore, WAIST-HIP RATIO is often used to determine health risks.
According to the National Arthritis Data Workgroup, an estimated 6 million people in the United States report having experienced gout at some point in their lives. In fact, gout is the most common form of inflammatory arthritis in men over the age of 40....
Arthritis Fibromyalgia Gout Lupus Rheumatic Rheumatology is the medical specialty concerned with the diagnosis and management of disease involving joints, tendons, muscles, ligaments and associated structures (Oxford Medical Diction...