Woman with Suddenly Painful, Swollen Thumb

September 24, 2014
Gregory R. Emkey, MD

The 45-year-old woman turned up in the emergency room with an acutely painful, swollen thumb. Aspiration results were uninformative. What's the diagnosis?

[[{"type":"media","view_mode":"media_crop","fid":"27957","attributes":{"alt":"acute calcific periarthritis","class":"media-image media-image-right","height":"209","id":"media_crop_890122252363","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2791","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; margin: 3px;","title":" ","typeof":"foaf:Image","width":"208"}}]]After 3 days of enduring an acutely painful, swollen thumb, the 45-year-old woman went to the emergency room seeking relief.

Aspiration was sterile and no crystals were visible upon light microscopy. A radiograph of her thumb appears at right.

Is this gout or pseudogout? Can you guess the cause?

Click here to see the diagnosis and discussion.