Review the Learning Outcomes, Hx, PE and Labs, and begin the module with your Provisional Diagnosis. Keep hitting "Next" to move through the module.
- Articulate your relationship with the consulting diagnostic radiologists in the evaluation of a patient with joint pain.
- Review the DDx considerations in a patient with joint pain.
- Identify the spectrum of imaging findings in appropriate modalities for evaluating patients with joint pain.
What is your assessment of the likely acuity for this patient?
First Imaging Study
What is the first imaging study you will order?
Pertinent Imaging Observations
Click on the links below to view images from the study, and assess these key findings as best you can.
There is soft tissue swelling.
The soft tissues are otherwise normal.
The cortex of the bone is normal.
Watch our video
Second Imaging Study
What is the next imaging study you will order?
What is your Diagnosis now that you have seen the imaging results?
Initially, you selected and we suggested acuity.
Has your concern for this patient changed?
Assessment and Plan
Please provide your assessment and plan for this patient
- Gout presents as extreme, sudden onset joint pain and swelling. It often affects the foot and knee. Food, medications, or conditions leading to increases in purine levels can lead to an acute episode. Medications that are nephrotoxic or lower urate can also lead to gout flares.
- The gold standard diagnostic technique for gout is an arthrocentesis which demonstrates negatively birefringent monosodium urate crystals.
- If an X-ray is obtained, a joint effusion can be evident in the acute stage. Chronic findings include erosive, lytic lesions with adjacent tophi.
- Overall, gout appears to be more prevalent in Black and Asian adults. Risk factors for gout, including low educational level, poverty, high BMI, and poor diet quality, were shown to be higher in black compared to white adults. While Asians were found to be more likely to seek ambulatory care for gout, they were less likely to receive allopurinol.
- The associations between poverty and gout as well as BMI and gout were more significant in women compared to men.
- A diagnosis of gout can be made based on clinical examination and joint aspiration alone, without the need for imaging.
That's the end of the module! Once you've reviewed the video(s), you can click here for another case challenge.