md-medicaldata

Authors

 

Jelena Golubović¹, Jasenka Vasić Vilić¹, Miroslav Mišović^1,2, Tijana Kosanović<sup>3

1</sup>Institute for Radiology, Military Medical Academy, Belgrade, Serbia
²Faculty of Medicine, University of Defense, Belgrade, Serbia
³Department of Radiology, General Hospital Pančevo, Pančevo, Serbia

 

UDK: 616.7-007.6 616.24-006.6-06

The paper was received 13.02.218. Accepted: 28.02.2018.

Rad primljen 13.02.218. Rad prihvaćen: 28.02.2018.

 

Corresponding author/ Autor za korespodenciju:

dr Jelena Golubović
Vojnmomedicinska akademija
Crnotravska 17,
11000 Beograd
mob: 062-251-770
e-mail: jelenagolubovic88@gmail.com

 

 

Sažetak

 

Uvod: Sekundarna hipertrofična osteoartropatija (HOA, Marie- Bumberger sindrom) predstavlja glavnu skeletnu manifestaciju paraneoplastičnog sindroma primarnih nemikrocelularnih karcinoma pluća (80%), a propratni je fenomen kongenitalnih srčanih i supurativnih plućnih oboljenja. Karakteriše je simetrični periostitis na dijafizama i metafizno- dijafiznim prelazima dugih kostiju gornjih i donjih ekstemiteta, batičasti prsti i otok ekstremiteta. Cilj: prikazaćemo značaj klasične radiografije u ranom dijagnostikovanju karcinoma pluća sa početnim znacima hipertrofične osteoartropatije.
Materijal i metode: pacijent starosti 60 godina, godinu dana se leči od osteoartroze, a kako su se bolovi intenzivirali, ponovo se javlja na pregled kod reumatologa koji indikuje RTG kolenih i skočnih zglobova u dva pravca. Rezultati: na prikazanim koštanim strukturama osim difuzne osteopenije, uočava se izražena proliferativna reakcija periosta obostrano i simetrično duž distalnih dijafiza femura i proksimalnih i distalnih dijafiza tibije i fibule. Na osnovu radiografija koštanih struktura postavljena je sumnja na HOA. Pregled je dopunjen standardnom radiografijom srca i pluća, na kojoj je uočena do tada nedijagnostikovana infiltrativna promena u plućnom parenhimu. Nakon dopunske dijagnostike i pato- histološke verifikacije, dokazano je da se radi o skvamocelularnom karcinomu pluća.
Zaključak: simetrični periostitis nekada može biti prva i sasvim diskretna promena na radiografijama skeleta kod pacijenata sa nedijagnostikovanim karcinomom pluća. Kada se ove promene uoče na kostima kod pacijenata u odrasloj populaciji, uvek treba posumnjati na karcinom pluća i pregled dopuniti radiografijom srca i pluća.

 

 

Ključne reči:

hipertrofična plućna osteoartropatija, Bambergerov sindrom, radiografija

 

 

Abstract

 

Introduction: Hypertrophic pulmonary osteoarthropathy (HOA, Marie- Bumberger syndrome) is a main skeletal manifestation of paraneoplastic syndrome in patients with non-small cell lung carcinoma (80%). It is also a phenomenon of cyanotic congenital heart diseases and suppurative lung diseases. Symmetric periostitis of diaphyseal and metadiaphyseal portion of tubular bones is radiographic hallmark of HOA, while painful and swallen joints are main clinicaly manifestations. Purpose: Present the importance of radiography in early diagnostics of lung carcinoma with initial signs of hypertrophic osteoarthropathy. Methods: 60-year-old patient with the progressive pain in the knees and ankles, has been treated from osteoarthrosis in period of one year. Within diagnostics was made radiography of the knees and ankles. Results: Radiography of the bone structures shows, bilateral and symmetric periosteal proliferation of the diaphysis of femur, tibia and fibula. Additional radiography of the thorax shows until now undiagnosed infiltrative mass in pulmonary parenchyma, behind the heart shadow. Pathohistological verification confirmed the squamous-cell carcinoma of the lung. Conclusion: Symmetric periostitis can be first sign or quite discrete change on the bone radiography in patientens with undiagnosed lung carcinoma. When it is presented as only sign on the bone radiography in the adults with painful joints, should be suspected in lung carcinoma and expand examination with chest radiography.

 

 

Key words:

hypertrophic pulmonary osteoarthropathy, Bamberger syndrome, radiography

 

 

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