To my complete amazement I just got a call from the referrer…who now confirms that the pt has chronic renal failure (not on dialysis, but followed by a nephrologist) and has a known history of gout.
Atul Taneja suggested amyloid could be seen in the context of CRF and might tie the 2 lesions together (though I don’t think the fat signal in the subcutaneous mass supports that?).
The biopsy is scheduled, so we should get an answer.
On Mon, May 20, 2024 at 5:20 PM hilary umans <hilary.umans> wrote:
This is a solid, non compressible mass in the subcutaneous soft tissues lateral to the distal fibula
MRI was recommended
Axial images show that the thick peripheral rind is mostly bright T1 / Dark PDFS signal and there is avid diffuse enhancement
But there is this uniformly enhancing intermediate T1 / dark PDFS masslike lesion in the anterolateral ankle
There is no joint narrowing, erosion or marrow edema / enhancement
I have no other history
I want to make the intra articular and subcutaneous mass fit with one diagnosis, but I am not sure
Could this be RA with enhancing synovitis and rheum nodule, but no joint narrowing or erosions?
Could this somehow be gout?
Is there nodular synovitis and in the joint and something else, tumor or mayb hemorrhagic fat necrosis in the lateral soft tissues?
Does this patient need a rheumatology or orthopedic oncologic consult?
