Neck swelling in a patient with gout – What is the cause?

We describe the case of a 55-year-old man with underlying tophaceous gout who presented with a 6-month history of multiple joint pains and associated constitutional symptoms. Physical examination revealed firm and non-tender swelling measuring 3x4 cm adjacent to the left clavicular head. This swelling did not move with deglutition. Neck imaging showed bilateral heterogeneous soft tissue lesions at the sternoclavicular, first costochondral and acromioclavicular joints. Multiple lytic lesions with cortical destruction involving the upper manubrium and distal ends of both clavicles were seen. Fine needle aspiration of the sternoclavicular joint yielded a small amount of synovial fluid, and its histopathological analysis confirmed the presence of monosodium urate crystal deposition. This case demonstrates a rare manifestation of tophaceous gout at the sternoclavicular joint, underscoring its ability to mimic other pathologies and the consequent challenges in diagnosis.