RESUMEN
We report the case of a 67-year-old female patient presenting swelling of the hands and feet and pain in both legs. Clinical examination and bone scintigraphy identify the triad "digital clubbing - arthritis - bilateral periostitis of the long bones", leading to a diagnosis of hypertrophic osteoarthropathy, a syndrome usually associated with pulmonary neoplasia. The thoracic CT-scan, followed by a biopsy, effectively diagnosed a right upper lobe adenocarcinoma. Surgical treatment of the neoplasia allowed the resolution of the clinical complaints and the pathological scintigraphic findings.
Nous rapportons le cas d'une patiente de 67 ans présentant des gonflements des mains et des pieds ainsi que des douleurs des deux jambes. L'examen clinique et la scintigraphie osseuse identifient la triade «hippocratisme digital - arthrites - périostite bilatérale des os longs¼, permettant de poser un diagnostic d'ostéoarthropathie hypertrophique, un syndrome habituellement associé à une néoplasie pulmonaire. Le scanner thoracique, suivi d'une biopsie, ont en effet diagnostiqué un adénocarcinome localisé au niveau du lobe supérieur droit. La prise en charge chirurgicale de la néoplasie a permis la résolution des plaintes cliniques et de l'aspect scintigraphique pathologique.
Asunto(s)
Adenocarcinoma , Artritis , Neoplasias Pulmonares , Osteoartropatía Hipertrófica Secundaria , Periostitis , Adenocarcinoma/complicaciones , Anciano , Artritis/complicaciones , Femenino , Humanos , Neoplasias Pulmonares/complicaciones , Osteoartropatía Hipertrófica Secundaria/complicaciones , Osteoartropatía Hipertrófica Secundaria/etiología , Periostitis/diagnóstico por imagen , Periostitis/etiologíaRESUMEN
Hypertrophic pulmonary osteoarthropathy(HPO)is a tumor-associated syndrome that features the triad of clubbed fingers, periosteal bone growth in long bones, and arthritis, and is often associated with an adenocarcinoma or squamous cell carcinoma. This report presents details of a case of HPO associated with pleomorphic carcinoma, which was relieved by treatment. A 47-year-old woman was presented with a complaint of generalized arthralgia. A physical examination showed swollen joints in the body and clubbed fingers. Chest CT revealed a mass shadow in the left upper lobe and ultrasound- guided biopsy findings led to a diagnosis of non-small cell lung cancer. Furthermore, bone scintigraphy indicated symmetrical accumulation in bones and joints throughout the body. A right upper lobectomy was performed along with combined chest wall resection and mediastinal lymph node dissection with an open chest, and the presence of lung cancer complicated with HPO was indicated. Pathological examination results revealed a diagnosis of pleomorphic carcinoma(pT4N0M0, Stage â ¢A). Systemic arthralgia was resolved on the first postoperative day. One year after surgery, a solitary brain metastasis developed and was removed, with no recurrence at the time of writing. Joint symptoms related to HPO can be expected to improve with treatment of pulmonary lesions, thus aggressive procedures for diagnosis and treatment are desirable.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Carcinoma de Células Escamosas , Neoplasias Pulmonares , Osteoartropatía Hipertrófica Secundaria , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/patología , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Osteoartropatía Hipertrófica Secundaria/cirugía , Osteoartropatía Hipertrófica Secundaria/complicaciones , Carcinoma de Células Escamosas/complicaciones , Artralgia/complicacionesAsunto(s)
Osteoartropatía Hipertrófica Secundaria/diagnóstico , Neoplasias Pleurales/diagnóstico , Tumores Fibrosos Solitarios/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/complicaciones , Osteoartropatía Hipertrófica Secundaria/diagnóstico por imagen , Osteoartropatía Hipertrófica Secundaria/patología , Neoplasias Pleurales/complicaciones , Neoplasias Pleurales/diagnóstico por imagen , Neoplasias Pleurales/patología , Radiografía , Tumores Fibrosos Solitarios/complicaciones , Tumores Fibrosos Solitarios/diagnóstico por imagen , Tumores Fibrosos Solitarios/patología , Tomografía Computarizada por Rayos XAsunto(s)
Dolor en Cáncer/prevención & control , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Neoplasias Pulmonares/tratamiento farmacológico , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Dolor en Cáncer/etiología , Femenino , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/patología , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/complicaciones , Osteoartropatía Hipertrófica Secundaria/patología , PronósticoRESUMEN
Primary hepatic angiosarcoma was diagnosed in a 59-year-old woman who presented an arthralgia of limbs and dry cough for 6 weeks. Physical examination revealed digital clubbing. A Tc-MDP bone scintigraphy showed diffusely increased uptake along the cortical margins of long bones, suggesting hypertrophic osteoarthropathy.
Asunto(s)
Hemangiosarcoma/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Osteoartropatía Hipertrófica Secundaria/diagnóstico por imagen , Femenino , Hemangiosarcoma/complicaciones , Humanos , Neoplasias Hepáticas/complicaciones , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/complicaciones , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Medronato de Tecnecio Tc 99mRESUMEN
Pachydermoperiostosis or primary hypertrophic osteoarthropathy, also known as Touraine-Solente-Gole syndrome, is a rare process, frequently inherited. In its complete form it is characterized by pachydermia (thickening of the skin), skeletal changes (periostosis) and acropachia (digital clubbing). Diagnosis can be made considering the typical clinical features and the histological feature. We report a patient of 25-year old man presented with joint pain involving in multiple joints for last 7 years and progressive enlargement of his hands and feet with profuse sweating of palms and soles for last 4 years. Physical examination revealed thickened skin with excessive furrowing of his forehead, dropping of both eyelids, clubbing of all fingers, toes and enlargement of his hands and feet with pamoplantar hyperhidrosis. Laboratory investigation shows raised CRP, X-ray feet lateral view showed normal heel pad thickness, new bone formation and periosteal elevation in lower end of tibia and fibula and skin biopsy showed dense fibrocollagenous tissue in dermis and subcutis and mild acanthosis. With this scenario he was diagnosed as primary hypertrophic osteoarthropathy (Pachydermoperiostosis). After diagnosis he was treated with cholchicine (0.6mg) twice daily, naproxen (500mg) twice daily, and risedronate (150mg) monthly. After one year his skin texture became less thickened, joint pain improved, there was no further enlargement of acral part of fore arm. In this report we review the characteristic features of this syndrome. We highlight the importance of ruling out secondary forms of hypertrophic osteoarthropathy and of a close follow-up of these patients because of complications that might develop on long-term. Although no treatment was satisfactory, we wanted to emphasize that NSAIDs, Cholchicine and risedronate could be an effective treatment option.
Asunto(s)
Artritis , Osteoartropatía Hipertrófica Primaria , Osteoartropatía Hipertrófica Secundaria , Adulto , Artritis/etiología , Humanos , Masculino , Osteoartropatía Hipertrófica Primaria/complicaciones , Osteoartropatía Hipertrófica Primaria/diagnóstico , Osteoartropatía Hipertrófica Secundaria/complicaciones , Osteoartropatía Hipertrófica Secundaria/diagnóstico , Piel/patología , SíndromeAsunto(s)
Adenocarcinoma/complicaciones , Neoplasias Pulmonares/complicaciones , Osteoartropatía Hipertrófica Secundaria/complicaciones , Síndromes Paraneoplásicos/complicaciones , Enfermedades de la Piel/complicaciones , Adenocarcinoma del Pulmón , Humanos , Masculino , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/diagnóstico , Síndromes Paraneoplásicos/diagnóstico , Enfermedades de la Piel/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
A 52-year-old male patient presented to our hospital with a history of secondary hypertrophic osteoarthropathy (HOA) associated with an abdominal neoplasia and blepharoptosis. He had finger clubbing, hyperhidrosis, and hypertrichosis. He also had a recent history of extensive abdominal surgery with a pathology report of myelolipoma. Routine blood work was unremarkable. Upper eyelid reconstruction with blepharoplasty, upper eyelid wedge resection, and brow suspension was performed to address his eyelid concerns. By this case report, we would like to attract notice that the eyelid involvement may be a part of HOA and to emphasize the importance of systemic and pathologic evaluation in failed blepharoptosis surgery.
Asunto(s)
Blefaroptosis/etiología , Párpados/patología , Osteoartropatía Hipertrófica Secundaria/complicaciones , Biopsia , Blefaroplastia , Blefaroptosis/diagnóstico , Blefaroptosis/cirugía , Párpados/cirugía , Humanos , Masculino , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/diagnóstico , RadiografíaRESUMEN
INTRODUCTION: Primary pulmonary lymphoma is a rare disease; diagnosis is often delayed because of atypical clinical presentation and slow progression. OBSERVATION: A 42-year-old woman consulted because of haemoptysis. Chest CT-scan showed multiple nodular calcified masses. A lung biopsy led to the diagnosis of pulmonary amyloidosis with pulmonary MALT lymphoma (mucosa-associated lymphoid tissue). The patient developed two paraneoplastic syndromes: a hypertrophic osteoarthropathy and mucinosis. CONCLUSION: Multiple nodular amyloidosis can be a mode of presentation for pulmonary lymphoma. Paraneoplastic syndromes must be systematically considered and can help in early diagnosis of the disease and its relapse.
Asunto(s)
Amiloidosis/patología , Neoplasias Pulmonares/complicaciones , Linfoma de Células B de la Zona Marginal/complicaciones , Osteoartropatía Hipertrófica Secundaria/patología , Síndromes Paraneoplásicos/patología , Adulto , Amiloidosis/complicaciones , Femenino , Humanos , Pulmón/patología , Neoplasias Pulmonares/patología , Linfoma de Células B de la Zona Marginal/patología , Osteoartropatía Hipertrófica Secundaria/complicacionesAsunto(s)
Adenocarcinoma/complicaciones , Artritis Reumatoide/etiología , Neoplasias Pulmonares/complicaciones , Osteoartropatía Hipertrófica Secundaria/complicaciones , Adenocarcinoma/diagnóstico por imagen , Artritis Reumatoide/diagnóstico por imagen , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/diagnóstico por imagen , CintigrafíaAsunto(s)
Artritis/patología , Neoplasias Esofágicas/complicaciones , Osteoartropatía Hipertrófica Primaria/patología , Osteoartropatía Hipertrófica Secundaria/diagnóstico por imagen , Artritis/etiología , Fatiga/etiología , Humanos , Masculino , Persona de Mediana Edad , Osteoartropatía Hipertrófica Primaria/etiología , Osteoartropatía Hipertrófica Secundaria/complicaciones , Osteoartropatía Hipertrófica Secundaria/patología , Radiografía , Pérdida de PesoRESUMEN
Hepatopulmonary syndrome (HPS) is a serious complication of end-stage liver disease, which is characterized by hypoxia, intrapulmonary vascular dilatation, and liver cirrhosis. Liver transplantation (LT) is the only curative treatment modality for patients with HPS. However, morbidity and mortality after LT, especially in cases of severe HPS, remain high. This case report describes a patient with typical findings of an extracardiac pulmonary arteriovenous shunt on contrast-enhanced transesophageal echocardiography (TEE), and clubbing fingers, who had complete correction of HPS by deceased donor LT. The patient was a 16-year-old female who was born with biliary atresia and underwent porto-enterostomy on the 55th day after birth. She had been suffered from progressive liver failure with dyspnea, clubbing fingers, and cyanosis. Preoperative arterial blood gas analysis revealed severe hypoxia (arterial O2 tension of 54.5 mmHg and O2 saturation of 84.2%). Contrast-enhanced TEE revealed an extracardiac right-to-left shunt, which suggested an intrapulmonary arteriovenous shunt. The patient recovered successfully after LT, not only with respect to physical parameters but also for pychosocial activity, including school performance, during the 30-month follow-up period.
Asunto(s)
Atresia Biliar/diagnóstico , Enfermedad Hepática en Estado Terminal/cirugía , Síndrome Hepatopulmonar/diagnóstico , Trasplante de Hígado , Adolescente , Fístula Arteriovenosa/etiología , Atresia Biliar/etiología , Cianosis/complicaciones , Disnea/complicaciones , Ecocardiografía Transesofágica , Enfermedad Hepática en Estado Terminal/complicaciones , Femenino , Arteria Hepática/anomalías , Síndrome Hepatopulmonar/diagnóstico por imagen , Humanos , Hipoxia , Osteoartropatía Hipertrófica Secundaria/complicacionesAsunto(s)
Cianosis/complicaciones , Conducto Arterioso Permeable/complicaciones , Osteoartropatía Hipertrófica Secundaria/complicaciones , Cianosis/diagnóstico , Conducto Arterioso Permeable/diagnóstico , Ecocardiografía , Femenino , Soplos Cardíacos/complicaciones , Humanos , Persona de Mediana Edad , Oximetría , Insuficiencia de la Válvula Tricúspide/complicacionesRESUMEN
This case presents a patient with congenital cyanotic heart disease in whom secondary hypertrophic osteoarthropathy was diagnosed. The symptoms of severe bilateral leg pain started 2 months before hospital admission. The presence of clubbing, painful swelling of the lower limbs and his comorbid condition roused the suspicion of hypertrophic osteoarthropathy and a skeleton radiograph of the lower limbs was performed. The last showed changes consistent with periosteal new bone formation, so a non-steroid anti-inflammatory drug was started with complete resolution of the debilitating pain. Hypertrophic osteoarthropathy is an uncommon disease that may be genetically acquired or secondary to other conditions affecting lungs, heart, liver or bowel. Considering it elusive pathogenesis, treatment options are scarce and symptomatic relief is still the main objective.
Asunto(s)
Cardiopatías Congénitas/complicaciones , Osteoartropatía Hipertrófica Secundaria/complicaciones , Adolescente , Humanos , Pierna/diagnóstico por imagen , Masculino , Osteoartropatía Hipertrófica Secundaria/diagnóstico por imagen , Radiografía , SíndromeRESUMEN
BACKGROUND: Finger clubbing in HIV infected children is associated with pulmonary diseases. Respiratory diseases cause great morbidity and mortality in HIV infected children. OBJECTIVE: To determine association between finger clubbing and chronic lung diseases in HIV infected children and their clinical correlates (in terms of WHO clinical staging, CD4 counts/percentage, anti-retroviral therapy duration and pulmonary hypertension). DESIGN: Hospital based case control study. SETTING: The Kenyatta National Hospital (KNH) comprehensive care clinic (CCC) for HIV infected children and Paediatric General Wards. SUBJECTS: The study population comprised of HIV infected children and adolescents aged eighteen years and below. RESULTS: Chronic lung disease was more common among finger clubbed (55%) than non finger clubbed patients (16.7%). Finger clubbed patients had higher risk of hypoxemia (46.7%), pulmonary hypertension (46.7%) and advanced disease in WHO stage III/IV (91.7%) compared to non-finger clubbed patients. Finger clubbed patients had lower CD4 cells count and percentage (median 369 cells, 13%) compared to non-clubbed patients (median 861 cells, 28%). Duration of ART use was shorter in finger clubbed patients (median 5.5 months) compared to non-finger clubbed patients (median 40 months). CONCLUSION: Presence of finger clubbing in HIV infected children was associated with chronic lung disease, advanced WHO stage, lower CD4 counts/ percentage, shorter duration of ART use and higher likelihood of developing pulmonary hypertension.
Asunto(s)
Infecciones por VIH/complicaciones , Enfermedades Pulmonares/complicaciones , Osteoartropatía Hipertrófica Secundaria/complicaciones , Adolescente , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Estudios de Casos y Controles , Niño , Preescolar , Enfermedad Crónica , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Hospitales Públicos , Humanos , Lactante , KeniaRESUMEN
Secondary hypertrophic osteoarthropathy (HOA), also known as Marie-Bamberger syndrome, is a rare neoplastic syndrome featuring clubbing of the tips of the digits, periosteal proliferation and synovial effusion of adjacent joints. We report a case where a patient without any other known medical condition developed persistent arthralgia and mobility restriction after bruising the left knee. As the initial X-ray examination of the knee showed a distinct periosteal proliferation of the left femoral bone, extended diagnostics were initiated during which a bronchial carcinoma was identified. After surgical removal of the primary tumor the symptoms of irritation in the knee joint recovered totally.