case_images: PMC7499288_01
case_images: X-ray of the right and left feet demonstrating bilateral bipartite sesamoid bone and absence of other alterations.
case_images: CRIOR2020-8890549.001.jpg
case_images: PMC7499288_01_CRIOR2020-8890549.001.jpg
case_images: fig1
case_images: CRP, negative; antinuclear factor, negative; rheumatoid factor, 5.3 U/mL; creatinine, 0.8 mg/dL; urea, 48 mg/dL; fasting glucose, 82 mg/dL; A1C, 5.2%; sodium, 139 mEq/L; potassium, 4.0 mEq/L; AST, 16 IU/L; ALT, 20 IU/L; triglycerides, 99 mg/dL; total cholesterol, 171 mg/dL; LDL cholesterol, 109 mg/dL; HDL cholesterol, 43 mg/dL; urinalysis, normal; and 24-hour urinary uric acid, 639 mg. Complementary investigation with foot X-ray showed only bilateral bipartite medial sesamoid (Figure 1), while magnetic resonance imaging (MRI) of the left foot demonstrated bipartite medial sesamoid with suspected stress fracture, diffuse marrow edema of the medial sesamoid, periarticular soft tissue edema, and small joint effusion (Figure 2).
case_images: Magnetic resonance imaging of the left foot demonstrating bipartite medial sesamoid, diffuse homogeneous bone marrow edema of the medial sesamoid, periarticular soft tissue edema, and small glenosesamoid joint effusion ((a) coronal T2 with fat saturation, (b) sagittal T2 with fat saturation).
case_images: CRIOR2020-8890549.002.jpg
case_images: PMC7499288_01_CRIOR2020-8890549.002.jpg
case_images: fig2
case_images: CRP, negative; antinuclear factor, negative; rheumatoid factor, 5.3 U/mL; creatinine, 0.8 mg/dL; urea, 48 mg/dL; fasting glucose, 82 mg/dL; A1C, 5.2%; sodium, 139 mEq/L; potassium, 4.0 mEq/L; AST, 16 IU/L; ALT, 20 IU/L; triglycerides, 99 mg/dL; total cholesterol, 171 mg/dL; LDL cholesterol, 109 mg/dL; HDL cholesterol, 43 mg/dL; urinalysis, normal; and 24-hour urinary uric acid, 639 mg. Complementary investigation with foot X-ray showed only bilateral bipartite medial sesamoid (Figure 1), while magnetic resonance imaging (MRI) of the left foot demonstrated bipartite medial sesamoid with suspected stress fracture, diffuse marrow edema of the medial sesamoid, periarticular soft tissue edema, and small joint effusion (Figure 2).
case_images: Dual-energy CT demonstrating sodium monourate deposits in both feet.
case_images: CRIOR2020-8890549.003.jpg
case_images: PMC7499288_01_CRIOR2020-8890549.003.jpg
case_images: fig3
case_images: Thus, due to the impossibility of joint puncture due to the absence of significant effusion, dual-energy computed tomography (CT) was performed, which identified deposits of sodium monourate crystals in several structures of the feet (Figure 3), which led to the diagnosis of gout.