Hello. My name is Jack Henry, DC, DACBR. I am Radiologist-in-Chief of Radiology Diagnostics, LLC
, an industry leader of Chiropractic Radiology Services and Digitized Spinographic analyses. All of our services are provided at no cost to doctor and no/low cost to patients.
Selected cases will be presented for your evaluation. The studies may or may not have abnormalities. Use the arrow keys or the scroll bar to carefully evaluate the films.Step 1:
Is the study abnormal or normal?Step 2:
If the study is abnormal, what is your best diagnosis?Step 3:
Which follow-up imaging option would be best?Step 4:
Compare your results with the correct diagnosis.
A 26-year-old male reports with severe right foot pain. There is moderate swelling with redness about the foot, most prominent at the first MTP joint.
There is marked periarticular osteopenia about the first MTP joint. The cortical margins appear paper thin with gross cystic and erosive changes. Pathological fracture can not be excluded. Soft tissue swelling is readily visualized. A small pressure erosion is also present at the base of the fourth metatarsal.
The changes noted and described above are consistent with gout. Although infection could have a similar presentation, it is not considered in this case as a differential. I have not personally seen many cases of gout in patients under 30 years old. Gout is considered a crystal induced arthropathy. Hyperuricemia is the underlying culprit secondary to diet/lifestyle, genetics, and/or under excretion of urate. Gout can be associated with or a precursor to more serious conditions including metabolic syndrome leading to potential renal failure.
FOLLOW UP PROTOCOL
A consultation with a rheumatologist is recommended.