Figure 8.

Tophaceous gout in a 73-year-old woman. (a) Panoramic transverse/short-axis gray-scale US image along the dorsal aspect of the right wrist shows markedly thickening and heterogeneous hyperechoic extensor carpi ulnaris tendon (ECU) related to tendinopathy with associated MSU crystal deposition (arrow). Note a large echogenic mass with posterior acoustic shadowing between the ECU and the fourth extensor compartment (4EC) related to a hard tophus (dashed arrow). (b) Long-axis gray-scale US image along the lateral aspect of the right elbow shows multiple small intra-articular echogenic foci related to MSU crystals (dashed arrows), undersurface erosion at the periphery of the capitellum (arrowhead) and cortical irregularity of the lateral humeral epicondyle subjacent to the heterogeneous common extensor tendon suggestive of chronic tendinopathy (arrow). C = capitellum. RH = radial head. (c) Long-axis gray-scale US image along the anterolateral aspect of the right elbow shows “double contour sign” along the radial head and capitellum articular cartilage related to MSU crystal deposition (arrows).