Articular tophaceous gout of the cervical spine: CT diagnosis.

A 62-year-old female was referred to the department of medical imaging with complaints of right cervico brachialgia. MDCT examination of the cervical spine was performed. An exophytic pseudotumoral enlargement of the right posterior articular process of C6 was first suspected on the axial native scan (A, white arrow) but multiplanar reconstructions (B) clearly identified the articular nature of the process. Some relatively intact segments of the articular space were still present and vacuum phenomenon was clearly visible (black arrowhead) excluding an associated synovial effusion. Similar lesions were also found at the level of the costovertebral joints of T1 (black arrows). Both sides of the joint space were symmetrically affected by deep massive well circumscribed erosions which where filled by spontaneously very dense material. Nodular deposits of the same dense material were also found outside the natural limits of bones and some exophytic bone projections had developed around theses nodular deposits. These findings, and particularly the dense material, were recognized as gouty arthritis with massive tophaceous deposits. Laboratory tests revealed an elevated acid uric level at 104 mg/l (n.v 2065 mg/l). The patient was re-called for complementary X-ray. Plain films of the cervical spine (not illustrated) were rather uncontributive because the destructive lesion of the C6-C7 articular process was very difficult to characterize; moreover the erosions of the costovertebral joints were not detectable. Nevertheless the diagnosis of gout was reinforced by the presence of multiple typical erosions (black arrows) and tophi (white arrows) on the plain films of the feet (Fig. C).