Figure 10: Subcutaneous tophaceous gout on US. Photograph (a) demonstrates soft tissue prominence (asterisk) without marked cutaneous inflammatory changes overlying expected location of the Achilles tendon. Longitudinal ultrasound image (b) shows densely shadowing echogenic focus overlying the Achilles tendon, consistent with subcutaneous tophus with peripheral calcification (arrowhead). Ach: Achilles tendon; Cal: calcaneus.