What's the most likely diagnosis?

• 68 year old male with cough

1. Ewing's sarcoma
2. Chronic osteomyelitis
3. Hypertrophic pulmonary osteoarthropathy
4. Osteosarcoma
5. Old trauma

Additional Image- Axial CT image of the chest

 

Additional Image

 

Axial CT image of the chest

 

Answer:

 

3. Hypertrophic pulmonary osteoarthropathy

 

 

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Hypertrophic Pulmonary Osteoarthropathy

General Considerations

• Occurs in a rare primary and much more common secondary form
• Primary form is known as pachydermoperiostitis (HOA)
• Secondary form (AKA Marie-Bamberg Syndrome) occurs with a wide variety of pulmonary malignancies and chronic suppurative diseases
  • Since it most commonly occurs with pulmonary disease it is known as hypertrophic pulmonary osteoarthropathy (HPOA)
• Secondary form (HPOA) produces symmetrical periostitis
• About 3-5% of patients with HOA have primary HOA
  • Remaining 95-97% have secondary HOA, or hypertrophic pulmonary osteoarthropathy (HPOA)
• HPOA occurs in about 5% of patients with bronchogenic carcinoma and 50% of patients with pleural mesothelioma
• HPOA may precede the discovery of the lung cancer

 

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