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tophus
Etiology:
1) may occur in gout
2) may refer to sialolithiasis
Pathology:
- avascular deposit of uric acid in periarticular fibrous tissue, cartilage of the external ear or kidney
- chalky white masses of uric acid, surrounded by inflammatory cells & fibrous tissue.
Clinical manifestations:
- painless, persistent, generally noninflammatory nodules
- many be palpable on physical examination
- may occur within joints or non-palpable tissues
- located around joints & in soft tissues
- predilection for the extensor surfaces of the
- elbows
- distal Achilles tendon
- fingers (proximal interphalangeal joints & distal interphalangeal joints)
- cartilaginous portions of the ears.
- acute gouty flares may occur at sites of tophi
Radiology:
- X-ray of affected joint(s)
- tophi appear as hyperdense soft tissue swellings
- calcifications may appear within tophi
- ultrasound is the most sensitive method to detect tophi
Complications:
- tophi are deforming, can interfere with function, & directly erode bone
- ulceration of overlying skin can occur
- infection can be difficult to treat because tophi are avascular
Differential diagnosis:
- arthritis mutilans
Management:
- see gout
Related
sialolithiasis (salivary stone)
General
gout
abnormal morphologic structure (malformation)
References
- Medical Knowledge Self Assessment Program (MKSAP) 15,
American College of Physicians, Philadelphia 2009
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025