2min chapter

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Ultrasound Use in Rheumatology

ACR on Air

CHAPTER

Ultrasound Diagnosis of Crystalline Arthropathy in Rheumatology

Exploring the role of ultrasound in distinguishing MSU and calcium pyrophosphate crystals for diagnosing gout, showcasing its effectiveness in identifying crystal features and guiding accurate diagnosis and procedures.

00:00
Speaker 2
I think the coolest thing for me about sending some of my patients to you for crystalline arthropathy is that you can actually see the crystals on ultrasound and you can differentiate between MSU crystals and calcium pyrophosphate crystals.
Speaker 1
To clarify, definitely ultrasound for the diagnosis of gout is highly helpful and you can actually diagnose this even when the patient is not in a flare. If you have a patient with hyperurisemia, their flare has already passed, but you're highly suspicious that there's still gout in the diagnosis. You can apply the ultrasound probe to the joint that was previously flared and you may see that pathanomonic double contour sign or hyperacholic aggregates that are described as sugar and water appearance. The gout crystals are much finer in appearance than CPPD crystals for instance, which tend to be larger and more rounded in appearance.
Speaker 2
Super cool because if you had a patient with a cute gout, traditionally we'd want to aspirate that joint, but we often see these patients later on after the episode has occurred. What a great opportunity to put an ultrasound there and convincingly diagnose gout just based on imaging.
Speaker 1
Now sometimes you will see crystals and it will be difficult to differentiate between gout and calcium crystals. Certainly gout and calcium crystals can coexist and since calcium crystals are larger than gout and sometimes you'll actually even see calcified tofai. That's when actually ultrasound is also helpful in discerning small joint effusions that you may not necessarily appreciate on the clinical exam so that you can do an ultrasound guided procedure to aspirate that small sample of fluid.
Speaker 2
Amazing.

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