Hypertrophic osteoarthropathy is characterised by periosteal reaction involving the diaphysis and metadiaphysis of the long bones of distal extremities without an underlying bone lesion. Clubbing of the fingers is seen most commonly in patients with lung, liver, and gastrointestinal disorders. When associated with a pulmonary condition, it is termed hypertrophic pulmonary osteoarthropathy (HPOA) and when associated with cancer is considered a paraneoplastic syndrome.
Hypertrophic osteoarthropathy has been referred to with multiple different terms, including: Pierre-Marie syndrome, Bamberger syndrome, osteoarthropatia hypertrophica, Mankowsky syndrome and Hagner syndrome.
It is usually painful and associated with clubbing of the fingers or toes.
The causes of hypertrophic osteoarthropathy include:
- gastrointestinal tract and liver
- familial (pachydermoperiostosis)
Typically seen as long bone metaphyseal and diaphyseal smooth periosteal reaction.
With disease progression, periostitis becomes more prominent or multilayered and extends to the epiphyses 1.
Tc 99m MDP bone scan
symmetric linear increase in tracer accumulation along diaphyseal and metaphyseal surfaces of long bones 4
General imaging differential considerations include:
- pachydermoperiostosis (primary hypertrophic osteoarthropathy)
- chronic venous insufficiency
- thyroid acropachy
- hypervitaminosis A
Consider the differential for a smooth periosteal reaction.
On bone scintigraphy, differentials include:
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- 2. Angel-moreno maroto A, Martínez-quintana E, Suárez-castellano L et-al. Painful hypertrophic osteoarthropathy successfully treated with octreotide. The pathogenetic role of vascular endothelial growth factor (VEGF). Rheumatology (Oxford). 2005;44 (10): 1326-7. doi:10.1093/rheumatology/keh720 - Pubmed citation
- 3. Chew FS. Skeletal Radiology. Lippincott Williams & Wilkins. (2010) ISBN:1608317064. Read it at Google Books - Find it at Amazon
- 4. Morgan B, Coakley F, Finlay DB et-al. Hypertrophic osteoarthropathy in staging skeletal scintigraphy for lung cancer. Clin Radiol. 1996;51 (10): 694-7. Pubmed citation