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MRI showed no bone marrow abnormalities, supporting the diagnosis of HPOA. Further investigation revealed a lung tumour; the patient\u2019s symptoms significantly improved following lobectomy. The differential diagnosis of periosteal new bone formation in the lower extremities includes various conditions. The absence of bone marrow lesions on MRI and the bilateral, symmetric distribution of changes are key diagnostic clues for HPOA.<\/jats:p>","DOI":"10.1136\/bcr-2025-269739","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T15:40:13Z","timestamp":1779464413000},"page":"e269739","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Hypertrophic pulmonary osteoarthropathy in bilateral distal tibia and fibula"],"prefix":"10.1136","volume":"19","author":[{"given":"Fumihiro","family":"Inoue","sequence":"first","affiliation":[{"name":"Departments of Foot and Ankle Surgery, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka Prefecture, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Taki","sequence":"additional","affiliation":[{"name":"Departments of Foot and Ankle Surgery, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka Prefecture, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunari","family":"Oshima","sequence":"additional","affiliation":[{"name":"Departments of Foot and Ankle Surgery, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka Prefecture, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Ukita","sequence":"additional","affiliation":[{"name":"Departments of Foot and Ankle Surgery, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka Prefecture, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"2026052208400441000_19.5.e269739.1","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1378\/chest.52.1.62","article-title":"Hypertrophic pulmonary osteoarthropathy","volume":"52","author":"Stenseth","year":"1967","journal-title":"Dis Chest"},{"key":"2026052208400441000_19.5.e269739.2","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.3892\/ol.2014.2022","article-title":"Hypertrophic pulmonary osteoarthropathy with primary lung cancer","volume":"7","author":"Qian","year":"2014","journal-title":"Oncol Lett"},{"key":"2026052208400441000_19.5.e269739.3","first-page":"7810","article-title":"Three cases of surgically treated primary lung cancer associated with pulmonary hypertrophic osteoarthropathy","volume":"74","author":"Kodate","year":"2015","journal-title":"Chest Surg Respir Med"},{"key":"2026052208400441000_19.5.e269739.4","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2017160052"},{"key":"2026052208400441000_19.5.e269739.5","doi-asserted-by":"publisher","DOI":"10.1002\/art.27584"},{"key":"2026052208400441000_19.5.e269739.6","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.09.7212"},{"key":"2026052208400441000_19.5.e269739.7","first-page":"189","article-title":"SAPHO syndrome--a pictorial assay","volume":"32","author":"Khanna","year":"2012","journal-title":"Iowa Orthop J"},{"key":"2026052208400441000_19.5.e269739.8","doi-asserted-by":"crossref","first-page":"150","DOI":"10.2177\/jsci.35.150","article-title":"A cases of acute lymphotic leukemia which was difficult to make a diagnosis of CRMO for moving arthralgia and periarticular swelling","volume":"35","author":"Kizawa","year":"2012","journal-title":"Jpn J Clin Immunol"},{"key":"2026052208400441000_19.5.e269739.9","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.09.3300"},{"key":"2026052208400441000_19.5.e269739.10","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-020746"},{"key":"2026052208400441000_19.5.e269739.11","first-page":"333","article-title":"The clinical spectrum of remitting seronegative symmetrical synovitis with pitting edema. 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