Hypertrophic pulmonary osteoarthropathy in a patient with pulmonary alveolar microlithiasis.
نویسندگان
چکیده
Hypertrophic pulmonary osteoarthropathy occurred in a patient with proved pulmonary alveolar microlithiasis, an association not previously reported. Pulmonary alveolar microlithiasis is an uncommon disorder of unknown aetiology, characterised by microliths within the alveoli. Diagnosis is usually made from the radiographic appearance."2 Finger clubbing has been reported in pulmonary alveolar microlithiasis,' 3 ' but not hypertrophic pulmonary osteoarthropathy. We report such a patient. increasing dyspnoea on exertion, and a cough producing yellow sputum. There was no relevant family history. On examination she was obese and had finger clubbing. Her wrists, ankles, metacarpophalangeal joints, and metatarsophalangeal joints were swollen, erythematous, and tender in response to light palpation. Auscultation of the chest disclosed bilateral basal end inspiratory crackles. The erythrocyte sedimentation rate was 80 mm in one hour. Rheumatoid factor was present and C reactive protein was increased. Arterial blood gases while she was breathing air were: pH 7-42, arterial carbon dioxide tension (Paco2) 4 2 kPa, arterial oxygen tension (Pao2) 9 9 kPa. Pulmonary function tests showed mild restriction and a transfer factor (TLCO) of 39% predicted. A chest radiograph (fig 1) showed very fine, sand like micronodules of calcific density, diffusely affecting both lungs. The appearance was unchanged from a radiograph taken 10 years earlier. Computed tomography of the chest showed diffuse bilateral calcified densities, predominDepartment of Chest Diseases, Hacettepe University, School of Medicine, Ankara, Turkey S Emri L Cop.u Z T Selquk A A Sahin Y I Baris Reprint requests to: Professor Y I Baris Case report Pulmonary alveolar microlithiasis was diagnosed in a 44 year old woman and confirmed by open lung biopsy. Three years later she reported intermittent bilateral pain in the knees and ankles of four months' duration. The pain was associated with swelling at rest and aggravated by walking. She also noted Figure I Chest radiograph showing veryfine, sand like micronodules of calcific density in both lungfields. 145 group.bmj.com on October 20, 2017 Published by http://thorax.bmj.com/ Downloaded from
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عنوان ژورنال:
- Thorax
دوره 46 2 شماره
صفحات -
تاریخ انتشار 1991