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

Background 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. Case Presentation 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. Conclusion This case highlights the diagnostic utility of point‐of‐care ultrasound in prolonged monoarthritis when invasive aspiration is unsuccessful/contraindicated.