[Secondary hypertrophic osteoarthropathy. Differential diagnosis of post-traumatic ossification of the interosseous crural membrane].
The case of a 48-year-old patient is presented, suffering from persisting pain in the right lower leg for more than a year following a distortion of the ankle. The patient was known to have a history of severe asthmatic disease. Conventional X-rays showed a periostitis of the lower tibia and fibula. To exclude a malignant process, an open biopsy was performed. Neither tumor nor any histological signs of chronic inflammation were found. The patient claimed to have a similar pain in the contralateral lower leg 5 months after initial biopsy. X-rays again showed signs of a periostitis of the tibia and fibula. Furthermore, an increase in isotopes in this area was found in a performed bone scan. Diagnosis of osteoarthropathia hypertrophicans was confirmed 2 years after onset of the first symptoms. Pathogenetic variables both of the primary and secondary forms of hypertrophic osteoarthropathy (HOA) are as yet not completely clarified. Secondary hypertrophic osteoarthropathy (SHOA) may be defined as a syndrome of the long bones with clubbing of the fingers and toes, and occurs in the process of chronic lung and mediastinal disease. We conclude that HAO detection may contribute to early detection of lung disease, especially bronchopulmonary cancer, before it becomes clinically and radiographically manifest.
Diedrich
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Klinik und Poliklinik für Orthopädie, Rheinische Friedrich-Wilhelms-Universität Bonn. diedrich_ortho_bonn@hotmail.com
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Zhou
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Perlick
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D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging; D007869:Leg Injuries / Q000150:complications; D008173:Lung Diseases, Obstructive / Q000150:complications; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000175:diagnosis* / Q000209:etiology; D010005:Osteoarthropathy, Secondary Hypertrophic / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011859:Radiography; D013997:Time Factors