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Ultrasound is used increasingly for diagnosing gout. Three sonographic features of monosodium urate (MSU) crystal deposition are double contour sign (hyperechoic enhancement of articular surfaces), tophus (hyperechoic aggregates), and a “snowstorm” appearance (floating hyperechoic foci representing MSU aggregates). Investigators analyzed data from 824 patients with clinically suspected gout and at least one swollen joint or subcutaneous nodule who were enrolled in an international multicenter study. All patients underwent both ultrasonography and joint or nodule aspiration. Although all ultrasonographers had training, they were not required to follow a formal scanning protocol.
Half the patients had MSU crystals on joint or nodule aspiration…