Lumbar spinal stenosis attributable to tophaceous gout: case report and review of the literature

Figures & data

Figure 1 A picture of the patient’s right hand.

Note: The arrow indicates the gouty tophus found at the right little finger.

Figure 2 Plain X-ray films of the lumbar spine showing no obvious abnormalities except slight degenerative lumbar scoliosis (anteroposterior view on the left and lateral view on the right).

Figure 3 Computed tomography (CT) images of the lower spine.

Notes: The images show a partially calcified, round mass in the spinal canal at level L3/4 (indicated by the arrow in the sagittal tomogram A), with a gas-like low-density nodule in the interior. The mass was shown on the axial tomogram to be situated in the right portion of the spinal canal (indicated by the arrow in B). Spinal stenosis was found at the L3/4 accordingly.

Figure 4 Lumbar spine magnetic resonance imaging (MRI) images demonstrating an abnormal round epidural collection at the L3/4 level, compromising the spinal canal and causing cauda equina compression (indicated by the arrows).

Notes: This collection was of soft-tissue intensity with surrounding reactive high signal on the T1-weighted image sequence (A and B). On the T2-weighted images, it appeared relatively hypointense with a high signal in the interior (C and D). Herniation of the L2–3 and the L4–5 discs was also noted.

Figure 5 Intraoperative pictures showing white chalky material deposited in the epidural space of the posterior and lateral spinal canal (A). This material was partially encapsulated by fibrous tissue and grossly infiltrated the bone and soft tissue in several areas, which was removed completely with a curette (B and C).

Figure 6 Microscopic examination of the specimen showed granulomatous tissue with structureless coagulative necrosis and fibrinoid necrosis (A and B).

Notes: The acid-fast stain was negative. Original magnification ×100.