Medical Imaging Analysis Report

1. Imaging Findings

Based on the provided bone scintigraphy, chest X-ray findings, and CT/MRI of the lower leg, the following key features have been observed:

• Bone scintigraphy (bone scan): Demonstrates increased subcortical radiotracer uptake in the tibia and/or other long bones, suggesting new bone formation or periosteal reactions. This pattern is consistent with the typical radiologic features of hypertrophic osteoarthropathy (HOA).
• Chest X-ray (posteroanterior and lateral views): Shows a not fully well-defined mass-like opacity in the left thoracic cavity with possible local pleural thickening or density changes, suggesting an underlying thoracic or pulmonary lesion (e.g., malignancy or chronic pleural disease). There may be a slight mediastinal shift, but clinical correlation is required.
• CT scan (chest, lower extremities):
  • Chest CT: Shows a localized lesion in the left lower lung field closely associated with the pleura; there may also be mild enlargement of hilar lymph nodes.
  • Lower extremity CT: Demonstrates bilateral periosteal proliferation, periosteal reactions, and mild soft tissue edema in the cortical regions of the tibia and fibula, lending further support to the presence of hypertrophic osteoarthropathy.
• MRI (transverse section of the lower legs): Shows mild to moderate signal changes indicating soft tissue edema around the tibia, with mild enhancement in the periosteum and bone marrow, suggestive of active inflammatory changes.

2. Possible Diagnoses

Taking into account the patient’s age (65 years), clinical presentation (clubbing, lower limb edema), and imaging findings of chest lesions and periosteal proliferations, the following diagnoses or differential diagnoses should be considered:

1. Malignancy-related Pulmonary Hypertrophic Osteoarthropathy (HOA): Commonly seen with lung cancer. In the presence of distal extremity joint pain, periosteal reaction, and clubbing, there should be a high index of suspicion for an underlying malignancy in the lung.
2. Hypertrophic osteoarthropathy secondary to chronic pleural disease: Chronic pleural infections, chronic empyema, or severe bronchiectasis can also induce hypertrophic osteoarthropathy. Although less common, these possibilities need to be clinically ruled out.
3. Other causes of clubbing: Conditions like congenital heart disease, liver disease, and inflammatory bowel disease can cause clubbing; however, given the imaging and patient’s age and symptoms, a pulmonary origin is most likely and warrants careful evaluation.

3. Most Likely Final Diagnosis

Considering the patient’s age, clinical symptoms (clubbing, lower limb edema, possible joint pain), chest X-ray/CT findings (suspicious pulmonary lesion), as well as bone scintigraphy and MRI with characteristic periosteal reactions, the most likely diagnosis is:

Pulmonary Hypertrophic Osteoarthropathy caused by a malignant lung tumor.

It is recommended to proceed with contrast-enhanced chest CT, bronchoscopy, or percutaneous lung biopsy to confirm the nature of the lung lesion.

4. Treatment Plan and Rehabilitation

1. Treatment Strategy

• Treatment of the primary disease: If a malignant lung tumor is confirmed, treatment options may include surgical resection (if the lesion is operable and the patient’s overall condition permits), chemotherapy, and/or radiotherapy. In cases where surgery is not possible or advanced disease is present, a comprehensive medical treatment plan is indicated.
• Symptomatic management: For joint pain and discomfort in the extremities due to hypertrophic osteoarthropathy, nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesics can be used. Appropriate physical therapy (e.g., physiotherapy, warm compresses) can also help relieve local symptoms.
• Nutritional and supportive care: Ensure adequate protein and micronutrient intake. Nutritional evaluation and support may be provided, if necessary, in consultation with a nutritionist.

2. Rehabilitation and Exercise Prescription

When formulating a rehabilitation and exercise plan, the patient’s overall functional status, baseline cardiopulmonary function, bone quality, and potential side effects of tumor treatment should be considered. The following suggestions are general guidelines and should be tailored to the individual:

• Exercise intensity and type:
  • Begin with low-intensity aerobic exercises such as slow walking or stationary cycling, 10-15 minutes per session, 3 times per week.
  • As tolerance improves, gradually increase to moderate-intensity aerobic exercise for 20-30 minutes per session, 3-5 times per week.
  • If joint pain is significant, water-based exercises (e.g., walking in water) can reduce weight-bearing stress; progression should be gradual without overexertion.
• Resistance training:
  • Once joint pain is controlled or alleviated, incorporate low-load resistance exercises targeting smaller muscle groups (e.g., using resistance bands), 2-3 times per week, 2-3 sets each session.
  • Monitor for increased pain or swelling; reduce intensity or pause exercise if symptoms worsen significantly.
• Flexibility and range of motion (ROM) training:
  • Perform light stretching daily, especially for lower limb muscle groups, holding each stretch for around 30 seconds without bouncing.
  • ROM exercises are best done after physical therapy or warm compresses to prevent adhesions and maintain muscle strength.
• FITT-VP principle: The exercise prescription should specify Frequency, Intensity, Time, Type, Volume/Progression:
  • Frequency: 3-5 sessions per week
  • Intensity: Low to moderate (self-perceived exertion of 4-6 on a scale of 1-10)
  • Time: 10-30 minutes of continuous aerobic exercise per session, or broken into intervals
  • Type: Low-impact activities like walking, cycling, or water-based exercises
  • Volume/Progression: Gradually increase workload or duration as tolerated and according to disease progression
• Safety monitoring: Because the patient may have underlying pulmonary pathology, monitor respiratory rate, heart rate, blood pressure, and oxygen saturation. If chest tightness, significant dyspnea, or marked fatigue occurs, prompt medical evaluation is required.