每日一题_2024.03.29

A 55-year-old woman with a 29-pack-year history of smoking presented with a 1.5-year history of pain in her fingers, wrists, hips, knees, and ankles. On physical examination, clubbing and slight thickening of the skin of the fingers and toes were noted (left image, right foot). There was mild tenderness on palpation of all her affected joints but no erythema or swelling. A cardiopulmonary examination was normal. Radiographs of the forearms, hands, femurs, tibia, and feet showed symmetric periostitis of the tubular bones (right image, right ulna and radius, arrows). Which of the following is the most appropriate next test in her evaluation?

一名有29包/年吸烟史的55岁女性因手指、手腕、臀部、膝盖和脚踝疼痛1.5年就诊。体格检查发现手指和脚趾出现杵状指，皮肤轻度增厚(左侧图像，右侧足部)。所有受累关节触诊有轻度压痛，但无红斑或肿胀。心肺检查结果正常。前臂、手、股骨、胫骨和足部的x线片显示管状骨对称性骨膜炎(右侧图像，右侧尺桡骨，箭头)。在她的评估中，下列哪项是最合适的下一个测试?

A. ANA

B. Anti-CCP and rheumatoid factor

C. Bone scan

D. Calcium, phosphorus, and PTH levels

E. Chest imaging

答案解析：

疼痛性关节病、骨膜炎和杵状指的组合提示考虑肥厚性骨关节病。肥大性骨关节病是一种以手臂和腿部远端皮肤增厚和骨骼扩张为特征的综合征，常与肺癌相关。胸部x线片显示左侧大肿块，随后的计算机断层扫描进一步表现为前纵隔肿块。肿块活检显示为低分化非小细胞癌。最终诊断为非小细胞肺癌继发肥厚性骨关节病。

正确答案：E