ARRS 2022 Abstracts

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E1487. Ouch! Gout Makes Me Want to Shout! Gout and Its Mimickers
Authors
  1. Marc-Andre Hamel; University of Rochester Medical Center
  2. Gregory Jew; University of Rochester Medical Center
  3. David Bass; University of Rochester Medical Center
  4. Johnny Monu; University of Rochester Medical Center
  5. Vanessa Zayas; University of Rochester Medical Center
Background
Gout, the most common crystalline arthropathy in the United States, is encountered daily in the radiology department. Understanding its common, uncommon, and mimicking manifestations are required for expedient diagnosis and treatment. Radiographs continue to play a fundamental and often initial role in the workup of gout; however, gout can often mimic other diseases on radiographs and other imaging modalities, delaying diagnosis and treatment. Ultrasound and dual-energy CT (DECT) can aid in the diagnosis and treatment evaluation but are not without fault. DECT pitfalls include advanced osteoarthritis, beam hardening artifact, image noise, and vascular calcifications.

Educational Goals / Teaching Points
The goals of this exhibit are to present common and uncommon early and end-stage gout findings on MSK imaging modalities (x-ray, ultrasound, and MRI); present DECT findings and pitfalls; and illustrate gout mimicking other disease processes (primary tumors and metastasis, osteoarthritis, inflammatory arthritis, myositis, etc.).

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Gout, infamously known as one of “The Great Mimickers,” has many characteristic imaging findings that help distinguish it from other arthritides. The most common findings include tophi, normal mineralization, joint spaces are preserved at the beginning of the process, sclerotic margin of erosion, intra-articular, juxta-articular erosion, overhanging edge of the cortex, and asymmetrical polyarticular distributions. Unfortunately, there are other presentations of gout that mimic other diseases, which will often warrant further imaging, delay diagnosis, and delay treatment. These presentations may mimic infection, masses/neoplasms, rheumatoid arthritis, and many others. A multi-modality approach will be used to present these different imaging manifestations of gout.

Conclusion
It is of utmost importance that radiologists are familiar with the early and common imaging features that can be seen with gout arthropathy, along with its less common presentations that could mimic other processes, so that gout can be considered in the differential diagnosis in some of these more challenging cases. This knowledge, along with understanding the different imaging modalities that are available to aid in this process, will ultimately result in the proper and early treatment of these patients, increase confidence in our practices, and improve patient outcomes.