初回CTで肺性肥大性骨関節症を伴う肺癌と診断し得た1例

A case of lung cancer with pulmonary hypertrophic osteoarthropathy diagnosed by initial CT

肥大性骨関節症は，ばち指，長管骨の骨膜新生，関節炎を三徴とする腫瘍随伴症候群の一つであり，進行肺癌に合併することが多い。肺癌の転移検索で骨シンチグラフィを撮像し，下肢骨の左右対称の集積から肥大性骨関節症が診断されることがある。医中誌にて2000～2020年の期間で「肺性肥大性骨関節症」を検索ワードとして検索したところ，初診時にCTのみで診断された報告例は認められなかった。

The patient was a male, in his 40’s. He presented to our hospital with complaints of lower extremity pain and dyspnea on exertion. Suspecting pulmonary thromboembolism with deep vein thrombosis, we performed contrast-enhanced CT of the chest and lower extremities. In addition to the lung tumor, periosteal reaction findings were observed in bilateral femurs and tibias, and the diagnosis of pulmonary hypertrophic osteoarthropathy associated with lung cancer was made. Pulmonary hypertrophic osteoarthropathy is considered to be a tumor-associated syndrome associated with intrathoracic tumors such as lung cancer, and imaging findings are important for diagnosis. Radiologists need to keep the above diseases in mind when they see lung tumors or periosteal reaction of the long bones.