A 45-year-old woman with a 27-pack-year history of smoking presented for evaluation of progressive distal finger enlargement and polyarthralgias, which had developed over a period of 18 months. During the previous 3 months, she had had pain in the long bones of both legs and a nonproductive cough. Physical examination revealed symmetric, distal, bulbar swelling of the soft tissue of the fingers (Panel A, arrows), a positive Schamroth test (absence of the normal diamond-shaped window created when the dorsal surfaces of the terminal phalanges of similar fingers are opposed) (Panel B, arrow), and loss of Lovibond's angle. A chest radiograph showed a 7-cm rounded opacity in the right upper lobe (Panel C, arrow). The patient underwent a right upper lobectomy. Histopathological analysis revealed stage IB adenocarcinoma of the lung with tumor-free margins. At a 6-month follow-up visit, the patient was asymptomatic, and the clubbing and bone pain had resolved (Panels D and E, arrows). At a 30-month follow-up visit, she remained asymptomatic and without evidence of cancer.
Faller and Atkinson NEJM 359 (13): e15, Figure 1 September 25, 2008
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