When Joint Aspiration Fails: Point-of-Care Ultrasound for Diagnosing Chronic Gout in Prolonged Monoarthritis

A 34-year-old man presented to our primary care clinic with persistent pain and swelling of the right first metatarsophalangeal joint lasting 3 months. A previous clinic had suspected gout based on hyperuricemia, but urate-lowering therapy was repeatedly withheld because of ongoing inflammation, resulting in prolonged symptoms managed only with nonsteroidal anti-inflammatory drugs.

Ultrasound-guided joint aspiration yielded a dry tap owing to highly viscous chalky material. Point-of-care ultrasound demonstrated diffuse hyperechoic intra-articular deposits and a double contour sign without synovial hypervascularity on color Doppler.

This case highlights the diagnostic utility of point-of-care ultrasound in prolonged monoarthritis when invasive aspiration is unsuccessful/contraindicated.