Hi Steve, I had another case that was query gout. The male patient was very sore at the 1st MTPJ (medial aspect). There was definitely synovitis. The medial capsule of the MTPJ looked thickened and echogenic. When I was looking through the cineloops, I don’t know if there could be a subtle double cortex sign?
On the comparison image of the left/right toe, I placed an arrow where I thought the echogenic area may be a just capsule thickening or does that look like tophus…?


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