Hypertrophic osteoarthropathy
Updates to Article Attributes
Hypertrophic osteoarthropathyis characterised by periosteal reaction without an underlying bone lesion involving the diaphysis and metadiaphysis of the long bones of distal extremities. 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.
Terminology
Hypertrophic osteoarthropathy has been referred to with multiple different terms, including: Pierre-Marie syndrome, Bamberger syndrome, osteoarthropatia hypertrophica, Mankowsky syndrome and Hagner syndrome.
Clinical presentation
It is usually painful and associated with clubbing of the fingers or toes.
Pathology
The causes of hypertrophic osteoarthropathy include:
- lung
-
bronchogenic carcinoma
-
non
small-small cell lung cancer is the strongest malignant association, particularly squamous cell cancer
-
non
- pulmonary lymphoma
- lung abscess
- bronchiectasis
- pulmonary metastases (especially from osteosarcoma)
- pleural fibroma
- mesothelioma
- cyanotic congenital heart disease
-
bronchogenic carcinoma
- gastrointestinal tract and liver
- familial
- idiopathic
Radiographic features
Plain radiography
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.
Nuclear medicine
- Tc 99m MDP bone scan
- symmetric linear increase in tracer accumulation along diaphyseal and metaphyseal surfaces of long bones 4
Differential diagnosis
General imaging differential considerations include:
Consider the differential for a smooth periosteal reaction.
-<a href="/articles/non-small-cell-lung-cancer">non small cell lung cancer</a> is the strongest malignant association, particularly squamous cell cancer</li></ul>- +<a href="/articles/non-small-cell-lung-cancer">non-small cell lung cancer</a> is the strongest malignant association, particularly squamous cell cancer</li></ul>
-</ul><h4>Radiographic features</h4><h5>Plain radiography</h5><p>Typically seen as long bone metaphyseal and diaphyseal smooth periosteal reaction.</p><p>With disease progression, periostitis becomes more prominent or multilayered, and extends to the epiphyses<sup> 1</sup>.</p><h5>Nuclear medicine</h5><ul><li>Tc <sup>99m</sup> MDP bone scan<ul><li>symmetric linear increase in tracer accumulation along diaphyseal and metaphyseal surfaces of long bones <sup>4</sup>- +</ul><h4>Radiographic features</h4><h5>Plain radiography</h5><p>Typically seen as long bone metaphyseal and diaphyseal smooth periosteal reaction.</p><p>With disease progression, periostitis becomes more prominent or multilayered and extends to the epiphyses<sup> 1</sup>.</p><h5>Nuclear medicine</h5><ul><li>Tc <sup>99m</sup> MDP bone scan<ul><li>symmetric linear increase in tracer accumulation along diaphyseal and metaphyseal surfaces of long bones <sup>4</sup>
-</li></ul><h4>Differential diagnosis</h4><p>General imaging differential considerations include</p><ul>- +</li></ul><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>
Image 7 X-ray (Frontal) ( create )
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