PROBLEM
A 50-year-old man complains of hand pain and swelling. What is your interpretation of this frontal view of his hand?

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ANSWER
The correct diagnosis is gout. In this case, the condition is quite advanced and is manifested by multiple areas of periarticular bone erosion with loss of articular cartilage. Note also the area of calcification in a tophus adjacent to the ulnar styloid, which also shows early erosion.

This series of diagnostic quizzes that challenge your ability to read a variety of x-ray films is edited by Dr. Keats, alumni professor of radiology at the University of Virginia School of Medicine in Charlottesville. Emerg Med 39(4):63-4, 2007