Chronic tophaceous gout: Scintigraphic findings on bone scan

A 79-year-old man with a documented history of gout and Paget's disease of the bone was referred for a whole-body bone scan as part of routine follow-up of his condition. Aside from obvious Paget's disease involving the skull, left humerus (with callus from a known fracture), and midthoracic vertebrae, the scan also indicated multifocal disease related to the known gout. These findings include diffuse markedly increased uptake in metacarpal and interphalangeal joints, expanding into the periarticular soft tissues, and focal pathologic uptake in the distal right leg and ankle. Radiologic correlation of the findings were consistent with chronic tophaceous gout. Because of the effective treatment of gout by colchicine, such tophi are rarely encountered.