Pain in the Thumb Related to Disease in the Lung
A 59-year-old man presented with a 6-week history of pain in the thumb. He also reported having a cough, weight loss, and a history of heavy smoking. Physical examination revealed swelling, redness, and tenderness over the first right metacarpal and a mass (10 cm in diameter) fixed to the thorax. Laboratory tests revealed a C-reactive protein level of 123 mg per liter and a leukocyte count of 34×109 per liter. A radiograph of the hand showed osteolysis of the first metacarpal (Panel A, arrow), and a chest radiograph showed a solid mass of the thoracic wall expanding into the subpleural space (Panel B, long arrow) and a tumor in the hilus of the right lung (Panel B, short arrow). A specimen of the metacarpal lesion obtained through needle aspiration was negative for bacteria. The final diagnosis was lung adenocarcinoma with osseous lesions of the hand and ribs. The patient received palliative care.
