Joint Clues to a Silent Killer: Hypertrophic Osteoarthropathy and Lung Cancer.

Abstract

54-year-old male presented with dyspnea on mild exertion of mMRC grade II, chronic cough, pandigital clubbing (figure 1A) along with painful swelling involving distal part of both forearms for past 1 year. He is a chronic smoker since past 30 years with a smoking index of 680. Investigations revealed anemia of chronic disease with slight A/G reversal. X ray of forearm showed distal periosteal new bone formation along the shafts of radius and ulna with surrounding soft tissue swelling (figure 1B). A computer enhanced tomography of chest showed a heterogeneously enhancing mass along pleural surface on left hemithorax (figure 1C). FDG-PET showed hypermetabolic uptake in that mass with an SUVmax of 26.2 (figure 1D). He was diagnosed as hypertrophic osteoarthropathy secondary to lung carcinoma. A PET guided biopsy from the lung mass confirmed the histological type to be adenocarcinoma of lung. He was started on combination chemotherapy with Pemetrexed and Paclitaxel and is currently under medical oncology follow up.