Presentation: 35 year old man presents with intermittent painful inflamed, swollen joints especially worst during sleep.

Diagnosis: Chronic tophaceous gouty arthritis.

Modality: X-Ray

Key Points and Findings: Multiple well defined punched out erosive lesions with sclerotic changes in a juxta-articular pattern. Over-hanging edges sometimes known as rate-bite erosions are seen at these locations. Surrounding soft tissues may demonstrate pathogomonic tophi which appear as opacities adjacent to the joint spaces on radiograph. Joint effusions can be seen. The joint space is intact in earlier stages of disease but there is in late stage disease joint space narrowing.

Credit: Case submitted by Dr. Mohammed MD to radRounds Radiology Network