Dual-energy Computed Tomography for Diagnosis of Gouty Tophus of Tibia with Pathological Fracture Simulating Malignancy
CYH Chan, KWK Tsang, KC Lai, MK Chan
Hong Kong J Radiol 2017;20:59-63
DOI: 10.12809/hkjr1715374
Gouty tophus with pathological fracture is rare and can mimic infection and malignancy. We report the first case of intra-osseous tophus of the tibia complicated by pathological fracture. Although rare, intra-osseous gouty tophus can present with pathological fracture and thus should always be considered in the presence of collateral evidence. Dual-energy computed tomography (DECT) is highly accurate in detecting intra-articular and peri-articular monosodium urate in gout. In our patient, DECT clearly depicted both intra-articular and peri-articular monosodium urate depositions. Nonetheless, this imaging technique is not without pitfalls. As illustrated in our patient, the intra-osseous component is wrongly shown as being monosodium urate free. We postulate that the intra-osseous location may be a potential pitfall of DECT. Radiologists and clinicians should keep this in mind during image interpretation.
Authors’ affiliation:
CYH Chan, KWK Tsang, KC Lai, MK Chan: Department of Radiology and Imaging, Queen Elizabeth Hospital, Jordan, Hong Kong
中文摘要
雙能量電腦斷層掃描診斷類似惡性腫瘤病理性骨折的脛骨痛風石病
陳彥豪、曾慧勤、黎國忠、陳文光
有病理性骨折的痛風石病罕見，可以類似感染和惡性腫瘤表現。我們報告首例脛骨骨內痛風石伴有病理性骨折。骨內痛風呈現病理性骨折雖罕見，但有附帶證據時仍應考慮。雙能量電腦斷層掃描（DECT）能準確地檢測痛風中的關節內和周圍的尿酸鈉。在我們的患者中，DECT清楚地描繪了關節內和周圍的尿酸鈉沉積。然而這種成像技術不是沒有缺陷。如本患者所示，其骨內組織錯誤地顯示為不含尿酸鈉。這可能是DECT的潛在缺陷。放射科醫生和臨床醫生在解讀圖像時應記住這一點。