ChiroACCESS Article



Diagnostic Imaging Case Report: A 72-year-old male reported with right hand pain and swelling



This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Jack Henry, DC, DACBR

  

Radiology Diagnostics, LLC



Published on

June 4, 2010

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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.

HISTORY


A 72-year-old male reported with right hand pain and swelling “on and off’ for the past two years.  The patient does not have a primary care physician.  The patient is diabetic and has hypertension.
 





FINDINGS

The study demonstrates diffuse and focal areas of soft tissue swelling.  Striking regions of periarticular erosion are present most prominent about the second PIP joint.


DISCUSSION

Crystal induced arthropathies are not uncommon in western cultures.  Diet and sedentary life styles that include high intakes of red meat, ETOH and sugars contribute to the occurrence of gout.  Obviously, genetics is also an important factor.  Gout can complicate other disorders including diabetes, renal disease and heart disease.


FOLLOW UP PROTOCOL

No further imaging is required.  Efforts to lower levels of uric acid through dietary changes in combination, when appropriate, with a fitness program are often very successful.  If conservative approaches are ineffective, some patients may be relegated to drug therapy (allopurinol).
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