57M with chronic bilateral knee pain.XRs look mostly normal.
At first I thought there was a large peripherally displaced posterior horn lateral meniscus flap (red arrow), but I see a tiny tear at the free edge of the LM body (blue arrow) without a clearly visible tear of the posterior horn.
Then I realized it looks like tophaceous infiltration of the extensor mechanism.
He is on Hydrochlorthiazide (a diuretic) that can predispose to gout, though he is not on Gout meds and doesn’t volunteer a history of gout.
I could access only 1 case report of intrameniscal tophus, but their images look very different.
What do you think?
Displaced meniscus flap tear?
Meniscal tophus? Or a combination of both? Other?
