An Unusual Initial Presentation of Gout at the Wrist: Extensor Tenosynovitis With Dual-Energy CT and MRI Correlation.

Gout involving the wrist as an initial presentation is uncommon, especially when manifesting as extensor tenosynovitis with tophaceous deposits. We present the case of a 34-year-old male with chronic wrist pain and a dorsal wrist mass whose diagnosis was established through multimodal imaging, including dual-energy CT (DECT) and MRI. DECT effectively identified monosodium urate (MSU) crystal deposits in the extensor tendons, while MRI demonstrated tenosynovitis and tophus infiltration, guiding surgical synovectomy. Postoperative recovery was favourable with the resolution of symptoms. This report highlights the diagnostic challenges of wrist gout and underscores the value of advanced imaging techniques in early detection and operative planning.