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Joint effusion as an indication of a lung disease

Published:August 18, 2016DOI:https://doi.org/10.1016/j.ejim.2016.08.004

      1. Indication

      A 64-year-old man suffered of long-standing joint effusions of both knees. Preceding cortisone injections had not led to a decline of effusions. Microbiological analysis of joint aspirate showed no germs. The patient was therefore referred for evaluation of a potential rheumatoid arthritis. Clinical examination confirmed significant effusions in both knees without any external inflammatory signs, other joints were not affected. Radiographs (Fig. 1, panel A) showed no osteoarthritis, but distinct periosteal proliferations (white arrows) of both distal femoral bones. Further diagnostic workup revealed a bronchial carcinoma (Fig. 1, panel B, red arrows).
      Fig. 1
      Fig. 1Radiological diagnostics in a case with joint effusions. Panel A: Radiographs show no osteoarthritis, but distinct periosteal proliferations (white arrows) of both distal femoral bones. Panel B: Computed tomography scan of the thorax revealed a bronchial carcinoma (red arrows).
      What is the diagnosis?

      2. Diagnosis

      “Secondary hypertrophic osteoarthropathy” was diagnosed and the patient was referred to thoracic surgery.
      Secondary hypertrophic osteoarthropathy (HOA), also known as Marie–Bamberger syndrome, is a rare neoplastic syndrome featuring digital clubbing, periosteal proliferation and synovial effusion of adjacent joints [
      • Tsai M.Y.
      • Jo-Ching W.
      • Wu F.Z.
      Hypertrophic pulmonary osteoarthropathy in a patient with lung cancer.
      ]. HOA is commonly associated with lung cancer [
      • Callemeyn J.
      • Van Haecke P.
      • Peetermans W.E.
      • Blockmans D.
      Clubbing and hypertrophic osteoarthropathy: insights in diagnosis, pathophysiology, and clinical significance.
      ]. The underlying pathophysiology remains unclear [
      • Callemeyn J.
      • Van Haecke P.
      • Peetermans W.E.
      • Blockmans D.
      Clubbing and hypertrophic osteoarthropathy: insights in diagnosis, pathophysiology, and clinical significance.
      ]. Rapid diagnosis of this syndrome might benefit patients because of detection of a malignant lung neoplasm at an earlier stage.

      Conflict of interests

      The authors have no conflict of interest to declare.

      References

        • Tsai M.Y.
        • Jo-Ching W.
        • Wu F.Z.
        Hypertrophic pulmonary osteoarthropathy in a patient with lung cancer.
        Intern Med. 2014; 53: 2757-2758
        • Callemeyn J.
        • Van Haecke P.
        • Peetermans W.E.
        • Blockmans D.
        Clubbing and hypertrophic osteoarthropathy: insights in diagnosis, pathophysiology, and clinical significance.
        Acta Clin Belg. 2016; 71: 123-130