44M with 1 month knee pain, MRI and XR, please help

There is a heterogenously dark signal mass contiguous with / apparently arising from the anterior horn of the lateral meniscus…completely separate from the ACL

I see there was an old MRI from 7 years ago…I can hallucinate something much smaller there

He has a known history of Gout
Have you seen tophi arising from the meniscus?
There are reports of mass like lesions in the joint, especially related to the cruciate ligaments…I only find one case report in the menisci–so I guess it can happen

Do you think there is a differential diagnosis?
PVNS, maybe? Other?
Before you recommend it, we do not have DECT capability, so that is not an option for us.

Thank you.

Hilary

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