A 62-year-old male patient was admitted, because a chest X-ray examination revealed an abnormal shadow (4 cm in diameter) in the left upper lobe. A transbronchial lung biopsy showed the features of adenocarcinoma. Chest and abdominal computed tomography (CT) scan showed the features of lymphangitis carcinomatosa, and bilateral metastatic adrenal tumors. After effective chemotherapy, he complained of arthralgia and a bone scintigram showed abnormal uptakes in his bilateral shoulder, knee and wrist. He was diagnosed with pulmonary hypertrophic osteoarthropathy (PHOA). The serum level of vascular endothelial growth factor (VEGF) was elevated to 424 pg/ml, while serum growth hormone (GH) and GH-releasing hormone were normal. Immunohistochemical analysis showed positive features of VEGF in the pulmonary tumor cells. He died of cachexia on May 2nd, 2001, more than 2 years after the diagnosis of pulmonary adenocarcinoma at stage IV.