Another quick follow-up on this case. I received several responses since my last email stating that they too have never seen such dense calcifcations/ossifications with gout, and especially atypical given the absence or paucity of erosions. However, I did aspirate one of the patient’s MTP joints and the aspirate was positive for monosodium urate. Strange manifestation of a common disease?
Drew
Hello-
Middle-age male with great toe pain/swelling x1 year. Previously told he had gout. Only imaging I have are bilateral foot x-rays. Multiple ossifications within the soft tissue of both great toes. Also area next to left 4th metatarsal neck.
I’m wondering about multiple Nora lesions (BPOP) or florid reactive periostitis. Not sure I know the difference between the two. Do you agree? Other thoughts? The bilaterality and multiplicity is somewhat strange to me.
