J Korean Soc Radiol.  2012 Feb;66(2):193-197. 10.3348/jksr.2012.66.2.193.

Tophaceous Gout Involving the Whole Spine: An Unusual Case Report

• Shin M
• Lee J
• Cho WH
• Kim JH
• Jeong MJ
• Kim SH
• Kim JY
• Kim SH
• Kang MJ
• Cho HS
• Lee HB

• KMID: 1439413
• DOI: http://doi.org/10.3348/jksr.2012.66.2.193

Abstract

Gout is a relatively common, crystal deposition disease, in which monosodium urate crystals are deposited in joint and periarticular tissues of the extremities. Involvement of the spine is exceedingly rare. Most patients with spinal gout present with symptomatic spinal cord compression. Diffuse involvement of tophi deposition inside the spinal central canal has not been reported. We now present a case of chronic tophaceous gout with extensive spinal involvement that resulted in diffuse spinal cord compression and led to paraplegia.

MeSH Terms

Extremities
Gout
Humans
Joints
Paraplegia
Spinal Cord Compression
Spine
Uric Acid
Uric Acid

Figure

• 

  Fig. 1 Conventional radiographs of a 52-year-old man with paraplegia and arthralgia. A. On a lateral view of the lumbar spine, a hyperdense line is noted in the anterior portion of the central canal (arrows). B. A foot AP view shows multiple radioopaque depositions in soft tissue (arrowheads) and marginal bony erosions in the 1st metatarsophalangeal, tarsometatarsal, talonaivcular and calcaneocuboidal joints (arrows). Subluxation of the 2nd-5th metatarsal joints is seen. C. A apicoposterior view of wrist shows radioopaque tophi (arrowheads).

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  Fig. 2 A sagittal T2-weighted image of the whole spine demonstrating a long heterogeneous low signal band of tophi deposited in the anterior epidural space (arrows). A focal erosion is noted at the anterior margin of the T6 body (arrowhead). The spinal cord was compressed from C3 to T8.

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  Fig. 3 MR images of cervical spine. A. T1-weighted sagittal MR images of cervical spine show heterogeneous intermediate (black arrow) to low (black arrowhead) signal intensity masses in the anterior epidural space, suggesting deposition of tophi. B. Fat-saturated T1-weighted sagittal images after gadolinium enhancement reveal no significant enhancement of tophi.

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  Fig. 4 Involvement of the costovertebral joint. Tophi are seen as hyperdense space-occupying lesions in the anterior epidural space (arrow) on an unenhanced axial CT image. Note the vertebral destruction around the right costovertebral joint due to deposition of tophi (black arrowhead).

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  Fig. 5 Involvement of facet joints and the atlantodental joint. A. Axial and sagittal T1-weighted MR images show tophi in the facet joint (arrows), resulting in narrowing of the neural foramen. B. Deposition of tophi in the atlantodental interval on a sagittal T2-weighted image (arrow).

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