PMC7276623_01
The left lower extremity (a) and the right lower extremity (b) preoperatively demonstrating gouty tophi with overlying ulceration to the left lower extremity.
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F1
On physical examination, the patient had a large, tennis ball-sized mass over his left knee anterior to the patella and patellar tendon, with a second irregularly shaped firm mass inferior to this (Fig. 1a). Over the right anterior knee, there were two large, firm masses (Fig. 1b).
Plain radiograph of the left lateral knee preoperatively demonstrating a soft tissue mass with calcium precipitation overlying the extensor mechanism.
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F2
Plain radiographs of the bilateral knees revealed large soft tissue masses anterior to the patella (Fig. 2 and 3).
Radiographic image of the right lower knee preoperatively demonstrating a soft tissue mass with calcium precipitation overlying the extensor mechanism.
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F3
Plain radiographs of the bilateral knees revealed large soft tissue masses anterior to the patella (Fig. 2 and 3).
Axial T2-weighted magnetic resonance imaging of the left knee preoperatively revealing an enhancing and heterogeneous soft tissue mass overlying the extensor mechanism.
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F4
Magnetic resonance imaging of the left knee was also performed which demonstrated heterogeneous masses consistent with tophi and peripheral enhancement with central necrosis (Fig. 4).
Histological evidence of biopsy showing gouty tophus.
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F5
A diagnostic biopsy was performed to rule out malignancy and to confirm tophaceous gouty masses (Fig. 5).
The left knee postoperatively demonstrating wound closure with a Jackson-Pratt drain.
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F6
Overlying necrotic tissue was removed and plastic surgery performed an adjacent soft tissue transfer for wound closure over a Jackson-Pratt drain (Fig. 6).
The right knee gouty tophi preoperatively (a) and during perioperative exposure (b).
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F7
Two months following excision of the left knee gouty mass, the patient returned and underwent planned resection of the gouty tophaceous mass over the anterior aspect of the right knee using a similar technique (Fig. 7).
Post-operative images of the right (a) and left (b) knee.
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F8
The surgical incisions appeared well healed and the patient had resumed his normal activities of daily living (Fig. 8).