CASE 2171 Published on 25.05.2003

Correlation of CT, MRI and scintigraphic bone scan in a case of lung carcinoma hypertrophic osteoarthropathy

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

Covelli EM, Donnianni T, Sullo P, Manfredonia L, Mazzarella G, Belfiore G

Patient

65 years, male

Categories
No Area of Interest ; Imaging Technique Nuclear medicine conventional, CT, CT, MR
Clinical History

The patient presented with clubbing of the digits and swelling of the legs.

Imaging Findings

The patient presented with clubbing of the digits and swelling of the legs.

A total-body scan was performed 3 hours after administration of an i.v. bolus of tracer (740MBq 99mTc-labelled diphosphonate) in anterior and posterior views using a double-head gamma-camera (Philips/ADAC - Vertex plus) equipped with low-energy, very high resolution (VXHR) collimators.

Following traditional chest X-ray, a CT-scan (GE - PACE plus) with contrast medium was performed on the chest for study of the lungs after a thigh bone study without contrast media.

MRI (Eclipse Philips-Marconi 1.5T) was perfomed on the thigh bones with TSE T1- and T2-weighted images on the coronal and axial planes.

Bone scintigraphy showed abnormal intense symmetrical uptake in the inferior limbs - hypertrophic osteoarthropathy. The traditional chest X-ray and CT scan showed lung cancer. The CT images of the thigh bones showed low periosteal proliferation. MRI of the femurs was negative in all sequences except for a dishomogeneous signal.

Discussion

Pulmonary hypertrophic osteoarthropathy is a syndrome of unknown aetiology, presenting with osteitis of the long bones, arthritis, and clubbing of the digits. It is frequently associated with lung cancer or other chronic pleural disease.

The literature reports 3% of cases of lung cancer associated with pulmonary hypertrophic osteoarthropathy in Europe.

In conclusion:

  • Bone scintigraphy is useful to detect hypertrophic osteoarthropathy and reveals the presence and extent of subperiosteal activity with greater clarity than CT or MRI.
  • The hypertrophic osteoarthropathy scintigram pattern may be the presenting manifestation of occult malignancy and should lead to an intensive diagnostic evaluation for cancer using chest X-ray as a first step.
Differential Diagnosis List
Lung cancer with hypertrophic osteoarthropathy
Final Diagnosis
Lung cancer with hypertrophic osteoarthropathy
Case information
URL: https://www.eurorad.org/case/2171
DOI: 10.1594/EURORAD/CASE.2171
ISSN: 1563-4086