0:00

This is a 70-year-old man with a finger mass

0:05

and a bone cyst.

0:06

He had an injury three weeks ago,

0:09

and I put this in specifically with Don in mind.

0:13

I'm gonna start out, let me flip them upright

0:16

so it's a little easier to get a feel for what's going on

0:21

and get them a little bit bigger.

0:24

And then, uh, let's go in the short axis projection.

0:28

There again are our, our sublimage tendons coming around

0:33

to form campers chiasma.

0:35

Now deep to the profundus.

0:37

Um, I didn't mention this,

0:38

but a lot of times you'll see this little

0:40

cleft in the profundus.

0:42

You don't wanna confuse that for a vertical tear.

0:45

I've seen that happen many times by young radiologists

0:48

and visiting scholars.

0:50

And, and here is the long axis projection.

0:52

You have these very curious looking

0:55

nodules along the finger.

0:57

Um, relative preservation of the joint space.

1:01

Really not a lot of inflammation, you know,

1:04

in the joint space.

1:06

Let's pull up one of the sagittals of the same finger.

1:10

And I, I think the, the lesions

1:13

and the erosions are reminiscent of the, the erosion

1:16

with an overhanging margin.

1:19

It's got a heterogeneous internal character to it.

1:22

And, and this is a proven case of gout of the hand.

1:26

Um, I thought you wanna comment on this one.

1:28

Um, uh, joint preservation sclerosis, kinda lack of a

1:33

lack of a big inflammatory response

1:36

and this diagnosis was made prospectively.

1:39

Uh, I would, uh, yeah, I would say, you know, if you see

1:43

single nodules, we always think

1:45

of tenino synovial giant cell tumor.

1:47

But when you deal with multiple nodules, uh,

1:52

gouty tophi, and there is a condition known as rheumatoid

1:56

nodus where the, the patients get multiple nodules and,

2:00

and locations, including the hands.

2:03

Um, yeah, gout, you know, as, as people know,

2:07

we get erosions and relative preservation of joint space.

2:11

And so that is a feature, the joint space preservation

2:15

that allows us to distinguish it from, uh,

2:18

from rheumatoid arthritis.

2:20

But that's a nice, uh, example of how well-defined

2:24

the erosions are.

2:26

And in many of 'em there is a low signal border

2:29

because these erosions occur slowly

2:32

and the reaction is, uh, bone sclerosis,

2:35

And he does have the low signal border.

2:37

And that if there ever was an overhanging margin

2:39

or edge, that, that, that, that is it.

2:42

Uh, another feature of this, this case that I think helps,

2:46

um, move you away from GCTS is the T two signal.

2:50

It's not a PD fat set, it's not fat set.

2:53

It's just a straight T two that would be highly unusual

2:56

for GCTS.

2:58

So that kind of pushes you at least in another direction.

3:01

Christine, any other comments about this case?

3:04

I think just emphasizing the facts, Steve, you know,

3:06

something Don always talks about as well,

3:08

that gout people think about it

3:09

as an articular based disease,

3:11

but it's really per articular in nature.

3:13

And I think this is a beautiful example of that.

3:16

Yeah. And for those, uh, you know, the,

3:18

the deal in arthritis, you know, gout is one

3:21

of those conditions that can affect virtually any joint.

3:24

Oh yeah. It can go distal, it can go proximal,

3:26

it can go MCP, whereas some of the others, you know,

3:29

have a predilection distal or proximal.

3:32

So gout is a real fooler.