Chest X-ray and nail clubbing

I’ve just returned from visiting the newly admitted patients to our day clinic. One lady, 56 years of age, has been admitted because of swollen knees. I noticed nail clubbing and she told me that it had developed about a year ago. Nail clubbing, also known as drum stick finger or water glass nails, is often associated with lung or heart diseases, but is also known in an idiopathic form (60% of all!). But if it develops quickly it is more often associated with malignancies. The first thing we did today was calling for a chest X-ray.

You can see a tumor in the upper quadrant of the right lung.

My question is, why does it take a year to do a simple chest X-ray? The face and the hands are easily seen. I guess it needs more awareness with primary care physicians.

More on nail clubbing:

http://en.wikipedia.org/wiki/Nail_clubbing

PS. 10.10.2012

Pictures of nail clubbing.

PPS. 11.10.2012

Now I can also show you the hand X-ray chart. The bone isn't involved, but one can see the nail clubbing (not as clearly as in photography).