Images in Clinical Medicine
New-Onset Clubbing Associated with Lung Cancer
N Engl J Med 2008; 359:e15September 25, 2008
- Article
A 45-year-old woman with a 27-pack-year history of smoking presented for evaluation of progressive distal finger enlargement and polyarthralgias, which had developed over a period of 18 months. During the previous 3 months, she had had pain in the long bones of both legs and a nonproductive cough. Physical examination revealed symmetric, distal, bulbar swelling of the soft tissue of the fingers (Panel A, arrows), a positive Schamroth test (absence of the normal diamond-shaped window created when the dorsal surfaces of the terminal phalanges of similar fingers are opposed) (Panel B, arrow), and loss of Lovibond's angle. A chest radiograph showed a 7-cm rounded opacity in the right upper lobe (Panel C, arrow). The patient underwent a right upper lobectomy. Histopathological analysis revealed stage IB adenocarcinoma of the lung with tumor-free margins. At a 6-month follow-up visit, the patient was asymptomatic, and the clubbing and bone pain had resolved (Panels D and E, arrows). At a 30-month follow-up visit, she remained asymptomatic and without evidence of cancer.
Bryan A. Faller, M.D.
John P. Atkinson, M.D.
Washington University School of Medicine, St. Louis, MO 63110
bryan.faller@fccc. edu - Citing Articles (2)
Citing Articles
1
Miiru IZUMI, Koichi TAKAYAMA, Hidetake YABUUCHI, Koichiro ABE, Yoichi NAKANISHI. (2010) Incidence of hypertrophic pulmonary osteoarthropathy associated with primary lung cancer. Respirology 15:5, 809-812
CrossRef2
R. P. Clark, M. L. de Calcina-Goff. (2009) Some aspects of the airborne transmission of infection. Journal of The Royal Society Interface 6:Suppl_6, S767-S782
CrossRef
