The use of U/S has recently increased in the evaluation of asymptomatic hyperuricemia which may go on for a considerable time before specific manifestations of gout become noticeable. Imaging showing crystal deposition and inflammatory manifestations may lead to the initiation of treatment for gout before the development of irreversible complications (1) . The double contour sign, floating microtophi and full tophi are known sonographic features of gouty arthritis. In this study we tried to identify different sonographic features of gouty arthritis and correlate them with the duration of arthritis in order to identify the sequential order of their appearance (2) . . 1. Perez-Ruiz F, Dalbeth N, Urresola A, de Miguel E, Schlesinger N. Imaging of gout: findings and utility. Arthritis research & therapy. 2009;11(3):232. Epub 2009/07/14. 2. Filippucci E, Riveros MG, Georgescu D, Salaffi F, Grassi W. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 2009;17(2):178-81. Epub 2008/07/29. 3. Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E. Standard reference values for musculoskeletal ultrasonography. Annals of the rheumatic diseases. 2004;63(8):, et al. Guidelines for musculoskeletal ultrasound in rheumatology. Annals of the rheumatic diseases. 2001;60(7):641-9. Epub 2001/06/19. 5. Martinoli C. Musculoskeletal ultrasound: technical guidelines. Insights into imaging. 2010;1(3):99-141. Epub. 7. Korkmaz M, Gunaydin I. Comments on the diagnostic role of ultrasonography in patients with gout. Lett Ed Rheumatol 2011; 1:e110008. doi:10.2399/ler.11.0008. 8. Ottaviani S, Bardin T, Richette P. Usefulness of ultrasonography for gout. Joint, bone, spine : revue du rhumatisme. 2012;79(5):441-5. Epub 2012/03/06. A descriptive cross-sectional study was carried out on 60 male and female patients aged 40 years or above with mono or oligoarthritis of the lower limb. U/S examination of 57 knees was done in both longitudinal (30 degree flexion, with quadriceps contraction) and transverse planes with anterior and posterior views. Twenty three 1 st metatarsophalangeal (MTP) joint was examined in dorsal, lateral and plantar views in longitudinal and transverse planes (3-5) . The bipolar method facilitated in some cases the identification of crystal clusters. Erosions were considered to be present when visualized in both the longitudinal and transverse planes, and with definite loss of bone cortex (6) . Microtophi were considered only when they had no posterior shadow and were <1 mm in size (7) . Decreasing gain improved detection of microtophi (8) . The same U/S settings were used for all patients