We report the case of a 31-year-old male whose initial imaging presentation was considered highly suspicious for an edematous accessory muscle, the anconeus epitrochlearis. Operative excision led to the diagnosis of tophaceous gout. If this etiology had been considered earlier in the patient's clinical course, his diagnostic evaluation may have been less involved. When faced with a soft tissue mass in the setting of gout, a soft tissue tophus should always be considered.