Photo Rounds

Severely swollen finger

A 91-year-old woman presented to her family physician (FP) with severe pain in her right middle finger. The finger had been swollen for about a year. Palpation of the distal interphalangeal joint demonstrated firmness, rather than fluctuance. The FP considered gout, calcinosis, and paronychia in the differential diagnosis. An x-ray of the finger was ordered.

What's your diagnosis?


The patient was told that this was an attack of gout, based on the x-rays that showed several tophi (monosodium urate deposits) in the soft tissue over the third distal interphalangeal joint. Subchondral bone destruction was also seen as typical punched out lesions under the tophi.

The patient was treated with oral colchicine for the acute attack and then sent to Rheumatology for further management. Her serum uric acid level was also elevated, as expected.

Photos courtesy of JM Geiderman, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Chumley H, Smith M. Gout. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill;2013:590-595.

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