Figure 3.

Tophaceous gout of the posterior elbow in 3 different patients. (a) Initial lateral radiograph of the left elbow in a 57-year-old man shows cortical erosion of the posterior olecranon (black arrow) with marked distension and somewhat increased density of the overlying olecranon bursa (white arrow). Note increased density of the distal triceps tendon (dashed black arrow). (b) Lateral radiograph of the left elbow of the same patient obtained after surgical debridement redemonstrated cortical erosion at the posterior olecranon (black arrow) and increased density of the distal triceps tendon (dashed black arrow) with interval marked improvement of posterior soft-tissue thickening. (c) Lateral radiograph of the right elbow in a 62-year-old man shows a soft-tissue mass involving the olecranon bursa with associated calcifications (arrow). (d) Sagittal T2-weighted with fat saturation MR image in a 60-year-old man shows a large bone erosion involving the posterior olecranon (white arrow) with associated mild bone marrow edema subjacent to a markedly thickened and irregular distal triceps tendon of heterogeneous increased signal intensity (black arrow). Note mildly distended irregular shaped, heterogeneous, predominantly high-signal-intensity olecranon bursa extending into the distal triceps tendon (white arrow) and additional high-signal-intensity subcutaneous edema at the posterior aspect of the elbow.