Presents to the hospital with persistent cough and hemoptysis.
Heavy smoker and has lost about 4 kg weight during the last 3 months.
Teaching points:
Lung cancer is the third most common cause of bone mets after breast and prostate cancer. Other primary solid malignancies with frequent extension to bone include: melanoma, renal Ca, thyroid Ca.
The bone scan is not a specific procedure to detect malignant involvement, however type and distribution of lesions are often characteristic.
Benign conditions mimicking bone mets include: fractures, benign tumors, Paget disease, and some metabolic disorders.
The bone scan is a highly sensitive, inexpensive procedure for complete evaluation of the whole skeleton and it forms part of general oncologic work-up in malignancies known to have bone affinity or in patients with any malignant condition suffering from bone pain. -Hypertrophic osteoarthropathy(HOA) is a clinical syndrome of clubbing of the fingers and toes, enlargement of the extremities, and painful, swollen joints.
HOA is characterized by symmetric periostitisinvolving the radius, fibula, femur, humerus, metacarpals, and metatarsals. The syndrome can be primary (5%) or secondary (95%). (More teaching points in the case).
