PMC5628693_01
A picture of the patient's right hand.. Note: The arrow indicates the gouty tophus found at the right little finger.
tcrm-13-1287Fig1.jpg
PMC5628693_01_tcrm-13-1287Fig1.jpg
f1-tcrm-13-1287
No joint swelling or tophi were found over the elbows, knees, ankles, and toes, except one gouty tophus, which developed on the right little finger 1 month earlier (Figure 1).
Plain X-ray films of the lumbar spine showing no obvious abnormalities except slight degenerative lumbar scoliosis (anteroposterior view on the left and lateral view on the right).
tcrm-13-1287Fig2.jpg
PMC5628693_01_tcrm-13-1287Fig2.jpg
f2-tcrm-13-1287
Imaging examinations of plain X-ray films showed no obvious abnormality of the lumbar spine except slight degenerative lumbar scoliosis (Figure 2).
Computed tomography (CT) images of the lower spine.. Notes: The images show a partially calcified, round mass in the spinal canal at level L3/4 (indicated by the arrow in the sagittal tomogram A), with a gas-like low-density nodule in the interior. The mass was shown on the axial tomogram to be situated in the right portion of the spinal canal (indicated by the arrow in B). Spinal stenosis was found at the L3/4 accordingly.
tcrm-13-1287Fig3.jpg
PMC5628693_01_tcrm-13-1287Fig3.jpg
f3-tcrm-13-1287
Computed tomography (CT) (Figure 3) showed a partially calcified, round mass in the spinal canal at the level of L3/4 with a gas-like low-density nodule in the interior. According to the axial tomography, the mass was situated in the right part of the spinal canal (Figure 3B).
Lumbar spine magnetic resonance imaging (MRI) images demonstrating an abnormal round epidural collection at the L3/4 level, compromising the spinal canal and causing cauda equina compression (indicated by the arrows).. Notes: This collection was of soft-tissue intensity with surrounding reactive high signal on the T1-weighted image sequence (A and B). On the T2-weighted images, it appeared relatively hypointense with a high signal in the interior (C and D). Herniation of the L2-3 and the L4-5 discs was also noted.
tcrm-13-1287Fig4.jpg
PMC5628693_01_tcrm-13-1287Fig4.jpg
f4-tcrm-13-1287
A lumbar spine magnetic resonance imaging (MRI) examination showed an abnormal round epidural collection at the L3/4 level, compromising the spinal canal and causing cauda equina compression (Figure 4A and B). This collection was of soft-tissue intensity with surrounded reactive high signal on the T1-weighted image sequence (Figure 4A and B). On the T2-weighted images, it appeared relatively hypointense with a high signal in the interior (Figure 4C and D).
Intraoperative pictures showing white chalky material deposited in the epidural space of the posterior and lateral spinal canal (A). This material was partially encapsulated by fibrous tissue and grossly infiltrated the bone and soft tissue in several areas, which was removed completely with a curette (B and C).
tcrm-13-1287Fig5.jpg
PMC5628693_01_tcrm-13-1287Fig5.jpg
f5-tcrm-13-1287
The same white chalky material was found in the epidural space of the posterior and lateral spinal canal (Figure 5A). This material was partially encapsulated by fibrous tissue and grossly infiltrated the bone and soft tissue in several areas, which was removed completely with a currette (Figure 5B and C).
Microscopic examination of the specimen showed granulomatous tissue with structureless coagulative necrosis and fibrinoid necrosis (A and B).. Notes: The acid-fast stain was negative. Original magnification x100.
tcrm-13-1287Fig6.jpg
PMC5628693_01_tcrm-13-1287Fig6.jpg
f6-tcrm-13-1287
Microscopic examination of the specimen showed granulomatous tissue with structureless coagulative necrosis and fibrinoid necrosis, while the acid-fast stain was negative (Figure 6).