SHM Converge Scientific Abstract ePoster Gallery-Hypertrophic Pulmonary Osteoarthropathy

Pdf Summary

This case report highlights hypertrophic pulmonary osteoarthropathy (HPOA) as an important but often overlooked sign of lung cancer. HPOA is a form of hypertrophic osteoarthropathy associated with pulmonary disease and classically presents with digital clubbing, joint pain, and periostosis of the long bones.<br /><br />The patient was a 72-year-old woman with COPD and a history of tobacco use who presented with several months of bilateral hand and lower-extremity swelling, diffuse joint pain, and difficulty standing from a chair. She did not report respiratory symptoms or weight loss. Physical exam showed digital clubbing, swelling, and pain out of proportion to exam findings. Labs were notable for hypokalemia, elevated alkaline phosphatase, and normocytic anemia.<br /><br />Imaging revealed a solid 2.5 cm spiculated right lower lobe pulmonary nodule on chest x-ray and CT chest. Lung biopsy confirmed non-small cell carcinoma, which was considered unresectable. Bone imaging showed periosteal reaction involving the long bones, metacarpals, and phalanges, consistent with advanced HOA. She was discharged with pain management and follow-up with rheumatology and oncology.<br /><br />The report emphasizes that HPOA may be a clue to underlying lung malignancy, with limited studies suggesting it occurs in 0.8% to 17% of cases of lung cancer. Proposed mechanisms include pulmonary shunting and fibroblast growth factor activity leading to collagen deposition, edema, and periostosis. Clinicians may look for Lovibond’s angle or Schamroth sign, though the utility of these findings is uncertain.<br /><br />Treatment focuses on symptom relief with NSAIDs, bisphosphonates, and addressing the underlying cancer. The key message is that unexplained joint pain and clubbing should prompt a thorough work-up for pulmonary malignancy, even without respiratory symptoms.

Asset Subtitle

Daria Hoang

Meta Tag

Author List Daria Hoang, Farzana Hoque, Joshua S. Kim

Category Clinical Vignettes

Concept Hypertrophic Osteoarthropathy

Concept Hypertrophic Pulmonary Osteoarthropathy

Concept Digital Clubbing

Concept Periostosis

Concept Lung Malignancy

Distinguished Non-Finalist

Presenter Organization Saint Louis University School of Medicine

Presenting Author Daria Hoang

Track Adult

Keywords

hypertrophic pulmonary osteoarthropathy

lung cancer

digital clubbing

periostosis

non-small cell carcinoma

pulmonary nodule

joint pain

COPD

bone imaging

tobacco use

Hypertrophic Osteoarthropathy

Hypertrophic Pulmonary Osteoarthropathy

Digital Clubbing

Periostosis

Lung Malignancy