This is a  Xray of the Right foot taken from a 57 years old man who was complaining of abrupt onset of  swelling  and pain of the big toe of  the right foot.He was a known patient with hypertension and was on Hydroclorothiazide.On examination of  the Big toe, it was hot,swollen and tender.
Identify the Xray changes and what is the Diagnosis?



  1. I think its gout and the swelling around the joint is soft tissue swelling or tophi...

  2. Anonymous Says:
  3. arash from iran
    very easy
    ghout arthritis

  4. Anonymous Says:
  5. sorry gout not ghout

  6. Anonymous Says:
  7. Shahrukh Hashmani from SMC, DUHS. Karachi, Pak.
    Acute gout.. reason

    1. Increasing age with male gender.
    2. Big toe of right foot (podagra)
    3. HTNsive and on diuretic.
    4. acute inflammatory condition.

  8. sunil Says:
  9. Acute Gouty Arthritis

  10. Anonymous Says:
  11. a cute gout arthritis...(podagra)

  12. Azhar Says:
  13. I think it is acute gouty arthritis
    Azhar from Iraq

  14. bone erosion,joint space narrowing,sclerosis,soft tissue shadow
    gouty arthritis

  15. Anonymous Says:
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  17. Anonymous Says:
  18. acute goute

  19. Anonymous Says:
  20. Kosta Div-OSMU
    easy one :) thats Goat

  21. Anonymous Says:
  22. Dr.Raju RPFU , Moscow
    According to the conditions given above it must be
    Acute Gouty Arthritis
    Elderly Person male
    HTN on diuretic.
    Abrupt onset of swelling and pain of the big toe of the right foot

  23. Anonymous Says:
  24. xray suggest more of chronic changes rather than the first acute episode

  25. Bobbymurjani Says:
  26. okay... gout arthritis.... i agree

  27. a Says:
  28. Dr Galala
    one of the side effects of thiazide diuretics is hyperuricemia
    this is a typical case of acute gouty arthritis

  29. Anonymous Says:
  30. acute gout
    bcoz big toe is typical site of pain,pt. is on hydrochlorothiazide that can cause hyperuricemia

  31. Anonymous Says:
  32. Gout

  33. Anonymous Says:
  34. gout

  35. Anonymous Says:

  37. Dr Casillas Says:
  38. se trata de una osteonecrosis mmm...Se han presentado casos de hiperglucemia tras la administración de hidroclorotiazida en individuos con diabetes mellitus en estado latente y la Diabetes Mellitus esta asociada a osteonecrosis, La hidroclorotiazida interfiere en la secreción tubular proximal de ácido úrico reduciendo su eliminación y agravando la hiperuricemia en los enfermos con gota. Aunque sólo se producen ataques de gota en el 20% de los pacientes con hiperuricemia, la administración de hidroclorotiazida puede desencadenar ataques de gota en estos pacientes.


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