Downloaded from www.ajronline.org by 186.182.136.36 on 10/12/15 from IP address 186.182.136.36. Copyright ARRS. For personal use only; all rights reserved
944
Improvement in Hypertrophic Pulmonary After Radiotherapy to Metastasis G. Muralidhara K. P. Poulose,3
Rao,’ G. H. Guruprakash,2 and G. BhaSkar4
Hypertrophic
pulmonary
soft
It is usually 4%-i
Bone
tissue
with
pulmonary 2%
of
scanning
of the
swelling,
associated
Hypertrophic in
osteoarthropathy
by clubbing
characterized periostitis,
with
fingers
and
is a syndrome
abnormality
toes,
demonstrated
arthritis,
and autonomic dysfunction. intrathoracic neoplasm [1 , 2].
osteoarthropathy
patients
with
has
bronchogenic
99mTc phosphate
shown to be a sensitive pulmonary osteoarthropathy
been
method for detecting [4-6]. Reversal
after
describe
lung
[3].
with
radiation
has been
tumor
hypertrophic of bone scan
on
metastasis
of
treated.
bone
scan.
of
such
a case.
B, Repeat
film.
Progression
the
with
primary
squamous
to the
pulmonary not
repeat
of
5]. a patient
treatment was
report
removal
[4,
in hypertrophic
found
carcinoma
compounds
We the
A
radius,
tumor
cell
This To
The
improvement
was
knowledge,
Received
February
21
,
1 979;
1 -A,
accepted
after
of Nuclear
2
Nephrology
Section,
3
Department
of Medicine, Veterans Administration Section, Medical Service, veterans
133:944-946,
Medical
November
Veterans
Service,
1979
film.
revision
Department
4 Respiratory
Medicine,
Initial
Infiltrate
June
in right
0361 -803X/79/1
lobe.
of lung
Medical
Administration
Center,
Medical
Leavenworth,
Center,
Medical Center, Leavenworth, Administration Medical Center,
335-0944
$00.00
KS
66048.
Address
Leavenworth,
KS 66048.
KS 66048. Leavenworth,
KS
© American
Roentgen
66048.
Ray Society
reprint
clearly this
tumor.
requests
after
primary
7, 1979.
Administration
Veterans
lower
of
improvement occurred
metastasis.
our
been
carcinoma
in whom
osteoarthropathy the
has
B Fig.
AJR
Osteoarthropathy
to G. M. Rao.
is
lung shown the
first
Downloaded from www.ajronline.org by 186.182.136.36 on 10/12/15 from IP address 186.182.136.36. Copyright ARRS. For personal use only; all rights reserved
AJR:133,
November
Fig.
Case
54-year-old
day,
in the of
white
was
and
kg.
before
end
right
He
who
to the
of femur.
smoked
hospital
wrist
had
with
coughed
Periosteal
elevation
and
two
increasing
up
of 3 months cough
a small
and
amount
tenderness
in the right
the
right
revealed
lung
on wrist.
base
squamous of hypertrophic
addition,
a lytic
1 A).
chestfilm
patient
developed
oration
of his
loss
the
long
lesion
involving
from
bones
pulmonary
swelling
the
infiltrate
showed
distal
lower (fig.
was
scan
was
on a large
field
for
image.
each
changes
(figs.
The pain
lesion in
the
not
right
bone
scan
Open
bone
cell
carcinoma.
3D-3F).
tion
treatment
radius period.
In
Repeat
of radiation Repeat
showed
300,000
documented
in
obtained
characteristic
osteoarthropathy
in many
treated
right with
resulted
radius
long
revealed
as
both
knees.
scan
with
and
5,500 The
the
to the right periarticular
radiography
after
of the
rad
in symptomatic
bone treatment
progression
were
lung
lung
(fig.
hypertrophic
wall
with
gradual
3 months
deteri-
later.
primary
tumor
patient
showed
after
bone
scan
within
ment
to a metastasis.
marked
clinical radiation
primary
lung
thropathy,
needed
1 B).
arthropathy.
that
not
improvement
tumor
takes
is
with of
improvement many
on
this
the
metastatic
in hypertrophic therapeutic
was
osteoarthropaRepeat since
several
hypertrophic
treat-
improvement
radiogit is known
months.
observation
contemplated
repeat
of radiation
performed
of this
treatment
in hypertrophic
spontaneously.
was
implication
Since
to
treatment
documented
pulmonary
regress
treatment
for
reported
radiation
completion
hypertrophic
bones
radiographic
One
after
It is unlikely
to
long
been
of
improvement as
1 week
known
of the
start
is
hyper-
[7].
since
is not
to the
associated
have
the
have
radiation
osteoarthropathy
and
tumor
osteoarthropathy,
of radiaThe
weeks
the
that
lung
osteoar-
mechanisms
by which
osteoarthropathy
within
spontaneous
pulmonary
humoral
pulmonary
with
pulmonary
when
technique
forearm showed concentration
completion tumor
relief
primary
same
in 1 5
and
mechanism
Patients
Our
thy
hypertrophic
relieves
pulmonary
performed
demonstrated
was
chest
of the
known.
raphy
pericortical chest
was
counts
of the
of radius.
He died
Neural
postulated;
improve
administration
extremities
biopsy
This
as well
wrist
reduction
(figs.
right
treated.
completion
dramatic
and
pulmonary
a 3 week
intravenous
of the
camera,
The
in the
over was
after
of view
squamous
sessions
3 hr after
Imaging
3A-3C).
metastatic
tumor
performed
of hypertrophic
bones
not
to
diphosphonate.
end
to the
condition.
is unclear.
trophic
2A).
2B). A bone
metastasis
general
pathogenesis
thropathy
tumor
lobe
characteristic
radius
in lower
Discussion
been
biopsy
right
osteoarthropathy the
and
bronchscopic
arising
lesion
4 days
disclosed
Fiberoptic
carcinoma
B, Lytic
of pain
weight
of blood
disclosed
Admission
of
Radiography
changes
admission
(fig.
cell
bronchus.
of 99mTc
formation.
The
examination
in
bone
of cigarettes
packs
because
new
admission.
Physical
(fig.
Lower
man,
admitted
knees
1 3.5
in
2.-A,
945
REPORTS
Report
A
per
CASE
1979
may in
be that
a patient
pulmonary deposit
may
pulmonary methods
with
osteoarbe
osteohave
been
Downloaded from www.ajronline.org by 186.182.136.36 on 10/12/15 from IP address 186.182.136.36. Copyright ARRS. For personal use only; all rights reserved
946
CASE
REPORTS
AJR:133,
E
D week
1 .000,000
reported
Periarticular
Decrease
and
pericortical
in periarticular
uptake
and
to
improve
symptoms we
as an objective
early
of
recommend
indicator
hypertrophic that
of this
4.
pulmonary
a bone
scan
be
pericortical
Freeman
MH,
monary
used
lung.
improvement.
ankles,
(All images
HE,
athy.
JAMA
Hyde
L, Hyde
65:299-306, Yacoub cinoma
20:537-539,
Bodey
AS:
Pulmonary
1 78:977-982,
Cl: Clinical
hypertrophic
osteoarthrop-
6.
1961 manifestations
of lung
cancer.
Chest
1974
L, Kirsh
and
feet.
at 300,000
MH: and
Relation hypertrophic
1965
between pulmonary
the
histology
of bronchial
osteoarthropathy.
carThorax
Manifestations in
D-E, Repeat counts
except
scans 1 A, at
of hypertrophic
patients
with
pul-
carcinoma
by 99mTc-pyrophosphate
bone
of scans.
the Ra-
1976 J: Observations
pulmonary
on radionuclide
osteoarthropathy.
imaging
Radiology
in 120:
1976
Terry
Jr DW,
ages
in hypertrophic
571-576, 7.
AK:
1 20:363-365,
Rosenthall
359-362, . Holling
Tonkin
Demonstration
hypertrophic
REFERENCES
3.
femora,
uptake.
osteoarthropathy
diology 5.
2.
in wrists,
counts.)
osteoarthropathy,
1
1979
F
3.-Bone scans. A-C, Before radiation to metastasis. after completion of radiation therapy to right forearm.
Fig
November
Steinfeld pulmonary 709-711,
Isitman
AT,
Holmes
pulmonary
RA:
Radionuclide
bone
osteoarthropathy.
AJR
im124:
1975
AD,
Muzenrider
osteoarthropathy 1974
JE:
The
response
to radiotherapy.
of
hypertrophic
Radiology
1 13:
944
Improvement in Hypertrophic Pulmonary After Radiotherapy to Metastasis G. Muralidhara K. P. Poulose,3
Rao,’ G. H. Guruprakash,2 and G. BhaSkar4
Hypertrophic
pulmonary
soft
It is usually 4%-i
Bone
tissue
with
pulmonary 2%
of
scanning
of the
swelling,
associated
Hypertrophic in
osteoarthropathy
by clubbing
characterized periostitis,
with
fingers
and
is a syndrome
abnormality
toes,
demonstrated
arthritis,
and autonomic dysfunction. intrathoracic neoplasm [1 , 2].
osteoarthropathy
patients
with
has
bronchogenic
99mTc phosphate
shown to be a sensitive pulmonary osteoarthropathy
been
method for detecting [4-6]. Reversal
after
describe
lung
[3].
with
radiation
has been
tumor
hypertrophic of bone scan
on
metastasis
of
treated.
bone
scan.
of
such
a case.
B, Repeat
film.
Progression
the
with
primary
squamous
to the
pulmonary not
repeat
of
5]. a patient
treatment was
report
removal
[4,
in hypertrophic
found
carcinoma
compounds
We the
A
radius,
tumor
cell
This To
The
improvement
was
knowledge,
Received
February
21
,
1 979;
1 -A,
accepted
after
of Nuclear
2
Nephrology
Section,
3
Department
of Medicine, Veterans Administration Section, Medical Service, veterans
133:944-946,
Medical
November
Veterans
Service,
1979
film.
revision
Department
4 Respiratory
Medicine,
Initial
Infiltrate
June
in right
0361 -803X/79/1
lobe.
of lung
Medical
Administration
Center,
Medical
Leavenworth,
Center,
Medical Center, Leavenworth, Administration Medical Center,
335-0944
$00.00
KS
66048.
Address
Leavenworth,
KS 66048.
KS 66048. Leavenworth,
KS
© American
Roentgen
66048.
Ray Society
reprint
clearly this
tumor.
requests
after
primary
7, 1979.
Administration
Veterans
lower
of
improvement occurred
metastasis.
our
been
carcinoma
in whom
osteoarthropathy the
has
B Fig.
AJR
Osteoarthropathy
to G. M. Rao.
is
lung shown the
first
Downloaded from www.ajronline.org by 186.182.136.36 on 10/12/15 from IP address 186.182.136.36. Copyright ARRS. For personal use only; all rights reserved
AJR:133,
November
Fig.
Case
54-year-old
day,
in the of
white
was
and
kg.
before
end
right
He
who
to the
of femur.
smoked
hospital
wrist
had
with
coughed
Periosteal
elevation
and
two
increasing
up
of 3 months cough
a small
and
amount
tenderness
in the right
the
right
revealed
lung
on wrist.
base
squamous of hypertrophic
addition,
a lytic
1 A).
chestfilm
patient
developed
oration
of his
loss
the
long
lesion
involving
from
bones
pulmonary
swelling
the
infiltrate
showed
distal
lower (fig.
was
scan
was
on a large
field
for
image.
each
changes
(figs.
The pain
lesion in
the
not
right
bone
scan
Open
bone
cell
carcinoma.
3D-3F).
tion
treatment
radius period.
In
Repeat
of radiation Repeat
showed
300,000
documented
in
obtained
characteristic
osteoarthropathy
in many
treated
right with
resulted
radius
long
revealed
as
both
knees.
scan
with
and
5,500 The
the
to the right periarticular
radiography
after
of the
rad
in symptomatic
bone treatment
progression
were
lung
lung
(fig.
hypertrophic
wall
with
gradual
3 months
deteri-
later.
primary
tumor
patient
showed
after
bone
scan
within
ment
to a metastasis.
marked
clinical radiation
primary
lung
thropathy,
needed
1 B).
arthropathy.
that
not
improvement
tumor
takes
is
with of
improvement many
on
this
the
metastatic
in hypertrophic therapeutic
was
osteoarthropaRepeat since
several
hypertrophic
treat-
improvement
radiogit is known
months.
observation
contemplated
repeat
of radiation
performed
of this
treatment
in hypertrophic
spontaneously.
was
implication
Since
to
treatment
documented
pulmonary
regress
treatment
for
reported
radiation
completion
hypertrophic
bones
radiographic
One
after
It is unlikely
to
long
been
of
improvement as
1 week
known
of the
start
is
hyper-
[7].
since
is not
to the
associated
have
the
have
radiation
osteoarthropathy
and
tumor
osteoarthropathy,
of radiaThe
weeks
the
that
lung
osteoar-
mechanisms
by which
osteoarthropathy
within
spontaneous
pulmonary
humoral
pulmonary
with
pulmonary
when
technique
forearm showed concentration
completion tumor
relief
primary
same
in 1 5
and
mechanism
Patients
Our
thy
hypertrophic
relieves
pulmonary
performed
demonstrated
was
chest
of the
known.
raphy
pericortical chest
was
counts
of the
of radius.
He died
Neural
postulated;
improve
administration
extremities
biopsy
This
as well
wrist
reduction
(figs.
right
treated.
completion
dramatic
and
pulmonary
a 3 week
intravenous
of the
camera,
The
in the
over was
after
of view
squamous
sessions
3 hr after
Imaging
3A-3C).
metastatic
tumor
performed
of hypertrophic
bones
not
to
diphosphonate.
end
to the
condition.
is unclear.
trophic
2A).
2B). A bone
metastasis
general
pathogenesis
thropathy
tumor
lobe
characteristic
radius
in lower
Discussion
been
biopsy
right
osteoarthropathy the
and
bronchscopic
arising
lesion
4 days
disclosed
Fiberoptic
carcinoma
B, Lytic
of pain
weight
of blood
disclosed
Admission
of
Radiography
changes
admission
(fig.
cell
bronchus.
of 99mTc
formation.
The
examination
in
bone
of cigarettes
packs
because
new
admission.
Physical
(fig.
Lower
man,
admitted
knees
1 3.5
in
2.-A,
945
REPORTS
Report
A
per
CASE
1979
may in
be that
a patient
pulmonary deposit
may
pulmonary methods
with
osteoarbe
osteohave
been
Downloaded from www.ajronline.org by 186.182.136.36 on 10/12/15 from IP address 186.182.136.36. Copyright ARRS. For personal use only; all rights reserved
946
CASE
REPORTS
AJR:133,
E
D week
1 .000,000
reported
Periarticular
Decrease
and
pericortical
in periarticular
uptake
and
to
improve
symptoms we
as an objective
early
of
recommend
indicator
hypertrophic that
of this
4.
pulmonary
a bone
scan
be
pericortical
Freeman
MH,
monary
used
lung.
improvement.
ankles,
(All images
HE,
athy.
JAMA
Hyde
L, Hyde
65:299-306, Yacoub cinoma
20:537-539,
Bodey
AS:
Pulmonary
1 78:977-982,
Cl: Clinical
hypertrophic
osteoarthrop-
6.
1961 manifestations
of lung
cancer.
Chest
1974
L, Kirsh
and
feet.
at 300,000
MH: and
Relation hypertrophic
1965
between pulmonary
the
histology
of bronchial
osteoarthropathy.
carThorax
Manifestations in
D-E, Repeat counts
except
scans 1 A, at
of hypertrophic
patients
with
pul-
carcinoma
by 99mTc-pyrophosphate
bone
of scans.
the Ra-
1976 J: Observations
pulmonary
on radionuclide
osteoarthropathy.
imaging
Radiology
in 120:
1976
Terry
Jr DW,
ages
in hypertrophic
571-576, 7.
AK:
1 20:363-365,
Rosenthall
359-362, . Holling
Tonkin
Demonstration
hypertrophic
REFERENCES
3.
femora,
uptake.
osteoarthropathy
diology 5.
2.
in wrists,
counts.)
osteoarthropathy,
1
1979
F
3.-Bone scans. A-C, Before radiation to metastasis. after completion of radiation therapy to right forearm.
Fig
November
Steinfeld pulmonary 709-711,
Isitman
AT,
Holmes
pulmonary
RA:
Radionuclide
bone
osteoarthropathy.
AJR
im124:
1975
AD,
Muzenrider
osteoarthropathy 1974
JE:
The
response
to radiotherapy.
of
hypertrophic
Radiology
1 13:
