This 58-years old man presented with a painful swelling over the radial aspect of the wrist. The radiograph showed an osteolytic lesion. Because of his pacemaker, a CT scan was done, which showed multiple osteolytic lesions in the distal radius and carpal bones with calcified soft tissue.
A biopsy was done, which showed some form of crystal arthropathy. His serum uric acid levels were elevated.
A dual energy CT of both elbows, wrists, hand and both knees, ankles and feet was performed. All the blobs of “green” reflect the presence of urate crystals, typical of gout. Usually in the Indian setting, florid tophaceous gout like this is not common. But in this patient, it has allowed us to clinch the diagnosis.
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