| 제목 |
Diagnosis of lung cancer in the patient with knee pain caused by hypertrophic osteoarthropathy |
| 소속 |
Department of Rehabilitation, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Department of Rehabilitation Medicine1, Korea Physical Medicine and Rehabilitation Clinic, Department of Rehabilitation Medicine2 |
| 저자 |
Da Ye Kim1*, Beom Jun Cho2, Jae Min Kim1*† |
Introduction
Patients with chronic knee pain are common and the symptom is mostly caused by degenerative disorders of the knee joint. Therefore, the cause of knee pain is easily considered an age-related disease. Though hypertrophic osteoarthropathy is a rare paraneoplastic syndrome, it can also cause knee pain. Herein we report an uncommon case of the patient with knee pain who finally diagnosed with hypertrophic pulmonary osteoarthropathy and lung cancer.
Case report
A 49-year-old man was referred to the department of rehabilitation medicine from a local clinic for uncontrolled both knee pain. He already had been treated with oral medication and several times of local injections. However, the pain recurred soon after the treatment. When he visited our department, he brought plain radiograph (Fig. 1) and magnetic resonance image(MRI) of the knee. However, they showed only prepatellar bursitis. Physical examination such as McMurray’s test, valgus and varus stress test was negative, and there was no definite tenderness around the knee. The only significant finding was swelling on the right patellar. Therefore, additional evaluation, the bone scan was done to fi
nd another cause of the knee pain besides degenerative disorder. The bone scan revealed symmetric linear uptake along diaphyseal and metaphyseal surfaces of both femur and tibia(Fig. 2). It was a typical radiographic feature of the hypertrophic pulmonary osteoarthropathy, which is characterized by abnormal proliferation of periostosis of tubular bones. Because non-small cell lung cancer is the most common secondary cause of the hypertrophic osteoarthropathy, the plain chest radiograph was taken and showed a mass at the left hilar region. We referred the patient to the pulmonologist. Chest computed tomography(CT) was taken and the mass biopsy was done with bronchoscopy(Fig. 3). The patient finally diagnosed with non-small cell lung cancer.
Conclusion
Chronic knee pain is so common in middle-aged and older patients that it is easily considered as osteoarthritis or bursitis without additional evaluation. However, if there no improvement after the treatment, hypertrophic osteoarthropathy should also be considered as one of the causes of knee pain.
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Plain knee radiograph. A. AP view B. Tangenital view C. Right lateral view D. Left lateral view
Bone scan shows linear uptake along diaphyseal and metaphyseal surfaces of both femur and tibia (arrow)
Chest plain radiography(A) and chest computed tomography(B) demonstrate mass(arrow) at the left hilar region.
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