J Korean Orthop Assoc.  2015 Aug;50(4):337-341. 10.4055/jkoa.2015.50.4.337.

An Intratendinous Tophaceous Gout Mistaken for Cellulitis in the Patellar Tendon

• Im SH
• Yang BK
• Nam SW
• Chung HS
• Yi SR
• Ahn YJ
• Kim SW
• Lee YH

• KMID: 2035872
• DOI: http://doi.org/10.4055/jkoa.2015.50.4.337

Abstract

Gout is characterized by recurrent attacks of arthralgia, and deposition of monosodium urate crystals in and around the joints of the extremities and soft tissues. Monosodium urate crystals are observed most frequently at the 1st metatarsophalangeal joint and usually presented in the ankle and wrist joint. However, no case of an intratendinous tophus in the patellar tendon has been reported in Korean literature. In this report, we found monosodium urate crystals in the patellar tendon on magnetic resonance imaging images and intratendinous tophus were visible to the naked eye by excision. We reported on the case of a patient who experienced an unusual intratendinous tophus in the patellar tendon.

Keyword

patellar tendon; gout

MeSH Terms

Ankle
Arthralgia
Cellulitis*
Extremities
Gout*
Humans
Joints
Magnetic Resonance Imaging
Metatarsophalangeal Joint
Patellar Ligament*
Uric Acid
Wrist Joint
Uric Acid

Figure

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  Figure 1 Knee joint anterioposterior view (A) and knee joint lateral view (B) shows no definite findings.

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  Figure 2 (A) T1-weighted spiral sagittal enhancement magnetic resonance imaging (MRI) shows edematous change from the prepatellar area to the pretibial area and rim enhancement at the infrapatellar fat pad area. (B) T1-weighted axial enhancement MRI shows fluid collection and peripheral rim enhancement in the middle of the patellar and retro-patellar tendon area.

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  Figure 3 (A) T2-weighted sagittal magnetic resonance imaging (MRI) shows intratendinous fluid collection along the patellar tendon and infrapatellar fat pad area. (B) T2-weighted axial MRI shows fluid collection in the middle of the patellar and retro-patellar tendon area.

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  Figure 4 (A) Intraoperative photograph shows white caseous materials. (B) Below the white caseous material, yellowish fluid collection was found.

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  Figure 5 Chalky white mass was found after dissection.

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