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    • #28357
      Xue Heng

      Hi, Steve! Happy new year!
      Thank you for giving us such a website full of treasure.
      Here is a new year case.
      The patient was a 37-year-old male with 1st MCP joint synovitis.
      However, there was hyperechoic material in the joint capsule.
      What is it?
      Thank you.

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    • #28405
      Stephen Bird

      HI Xue,

      Happy new year to you as well (Except it is not Chinese new year !)

      This looks like gout to me,

      You can see the synovitis in the joint capsule, and associated hyperaemia,

      You can also see crystals deposited on the surface of the hyaline cartilage and this is most likely monosodium urate crystal deposition from gout.

      CPPD is possible, but less likely.

      If it is CPPD you may see the crystals on a plain x-ray, if it is gout as I suspect you will not see the crystals on the X-ray but you may see some other clues (erosion etc)

      Nice one Xue,


    • #30228
      Xue Heng

      Thank you, Steve.
      I think CPPD is frequently associated advanced degenerative changes, which was absent in this 37-year-old patient.
      This made the diagnosis of CPPD more unlikely.

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