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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
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Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Practice Cases
Week 1
6 topics, 11 min.
Practice Cases
Week 2
6 topics, 18 min.
Practice Cases
Week 3
6 topics, 27 min.
Practice Cases
Week 4
6 topics, 7 min.
Practice Cases
Week 5
6 topics, 45 min.
0:00
This is a 46-year-old man who has stiffness
0:04
and swelling centered at the first MTP joint.
0:08
Sagittal T1 and long-axis fascial scans
0:14
images demonstrate a lobulated soft tissue mass.
0:20
Intermediate to low signal intensity on
0:22
T1, as well as low signal intensity
0:25
on T2-weighted images exerting
0:29
pressure upon the distal metatarsal.
0:34
The head of the first metatarsal is eroded as well
0:38
as the base of the great toe proximal phalanx.
0:43
So these are erosions with
0:45
overhanging edges in the setting of.
0:50
Synovial-based disorder with deposition of low
0:54
signal intensity, nodular, intra-articular,
0:59
mass-like lesion in the setting of gout.
Wk 4, Case 5 - Review
HIDEInteractive Transcript
0:00
This is a 46-year-old man who has stiffness
0:04
and swelling centered at the first MTP joint.
0:08
Sagittal T1 and long-axis fascial scans
0:14
images demonstrate a lobulated soft tissue mass.
0:20
Intermediate to low signal intensity on
0:22
T1, as well as low signal intensity
0:25
on T2-weighted images exerting
0:29
pressure upon the distal metatarsal.
0:34
The head of the first metatarsal is eroded as well
0:38
as the base of the great toe proximal phalanx.
0:43
So these are erosions with
0:45
overhanging edges in the setting of.
0:50
Synovial-based disorder with deposition of low
0:54
signal intensity, nodular, intra-articular,
0:59
mass-like lesion in the setting of gout.
Report
Patient History
46-year-old man with a history of gout, complaining of enlargement and stiffness of the right great toe.
Findings
Skeletal/osseous:
3.8 x 3.4 x 2.7 centimeter heterogenous intermediate T1 signal, T2 hypointense signal tumefactive soft tissue mass centered around the dorsal aspect of the 1st metatarsophalangeal joint, with a portion of the mass extending to the plantar aspect of the joint. Heterogenous, predominantly peripheral enhancement is noted within the mass postcontrast. Central component demonstrates mild T2 hyperintensity. Prominent/large underlying pressure- and hook-type erosions with overhanging edges are noted at the dorsal aspect of the base of the proximal phalanx and 1st metatarsal head. Further erosive change is seen at the plantar aspect of the 1st metatarsal head.
Further large erosions with overhanging edges are noted around the 3rd metatarsal base (adjacent to the metatarsophalangeal joint). A prominent juxta-articular erosion with overhanging edges is seen at the lateral aspect of the 5th metatarsal head.
Flexion deformities of the 2nd to 5th digits, consistent with claw toe deformities.
No micro- or macro-trabecular fracture.
Articulations:
Severe erosive arthropathy involving the 1st metatarsophalangeal joint as described above. Further moderate-to-marked erosive arthropathy involving the 3rd tarsometatarsal articulation and 5th metatarsophalangeal joint.
Mild midfoot arthrosis with periarticular erosions at the dorsal aspect of the medial cuneiform. Associated mild stress-related osteoedema.
Lisfranc joint:
Intact.
Tendons:
Mild focal tendinosis of the distal flexor hallucis longus tendon. Otherwise intact and unremarkable in appearance.
Ligaments:
Destruction of the 1st metatarsophalangeal joint collateral ligaments.
Plantar plates:
Intact.
Soft tissues:
Large soft tissue mass surrounding the 1st metatarsophalangeal joint as described above. Soft tissue thickening/callus formation adjacent to the 5th metatarsal head, consistent with altered biomechanics of weight-bearing.
Other:
Moderately atrophic intrinsic muscles of the forefoot.
Impressions
1. Large centrally necrotic soft tissue mass surrounding the 1st metatarsophalangeal joint, consistent with tumefactive gouty tophus (compatible with known history of gout).
2. Large osseous erosions at the 1st metatarsophalangeal joint, typical for gout.
3. Erosions of the midfoot and forefoot with overhanging edges, consistent with gout.
Case Discussion
Faculty
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Todd D. Greenberg, MD
Radiologist
ProScan
Tags
Musculoskeletal (MSK)
MRI
Foot & Ankle
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