PMC3515934_01
(a and b) Multiple nodules overlying deformed joints seen in the hand of a chronic patient with tophaceous gout.
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F1
Some lesions had ulcerated discharging white chalky material [Figures 1a and b].
Soft tissue radiograph of hand shows swelling and arrows point to bone erosion.
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F2
Radiographic evaluation of both hands showed soft-tissue swelling and periarticular erosions in the lower end of radius and interphalangeal joints with sclerotic margins and overhanging edges [Figure 2].
Transthoracic echocardiogram in apical 4 chamber view: Arrow points to a hyperechoic, oval-shaped mass on the mitral valve.
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F3
Transthoracic echocardiogram showed a hyperechoic, oval-shaped mass measuring 1.5 x 1 x1 cm on posterior mitral leaflet not reducing significantly the opening area of the valve (3.0 cm2), but he had trivial mitral regurgitation [Figure 3].