Hypertrophic osteoarthropathy
Updates to Article Attributes
Hypertrophic osteoarthropathyis characterised by periosteal reaction without an underlying bone lesion. It involves 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 lungpulmonary condition it is termed hypertrophic pulmonary osteoarthropathy (HPOA) and when associated with cancer is considered a paraneoplastic syndrome.
Terminology
Hypertrophic osteoarthropathy has has been referred to with multiple different terms, including: Pierre-Marie syndrome, Bamberger syndrome, Osteoarthropatiaosteoarthropatia 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 cell lung cancer is the strongest malignant association, particularly squamous cell cancer
.
-
non small cell lung cancer is the strongest malignant association, particularly squamous cell cancer
- 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
ConventionalPlain 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
-
Tc99m MDP bone scan
- symmetric linear increase in
tracertracer accumulation along diaphyseal and metaphyseal surfaces of long bones4.
- symmetric linear increase in
Differential diagnosis
General imaging differential considerations include
Consider the differential for a smooth periosteal reaction.
-<p><strong>Hypertrophic osteoarthropathy</strong><em> </em>is characterised by periosteal reaction without an underlying bone lesion. It involves 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 lung condition it is termed <strong>hypertrophic pulmonary osteoarthropathy (HPOA)</strong> and when associated with cancer is considered a <a href="/articles/paraneoplastic-syndromes">paraneoplastic syndrome</a>. </p><h4>Terminology</h4><p>Hypertrophic osteoarthropathy has been referred to with multiple different terms, including: <strong>Pierre-Marie syndrome</strong>, <strong>Bamberger syndrome</strong>, <strong>Osteoarthropatia hypertrophica</strong>, <strong>Mankowsky syndrome</strong> and <strong>Hagner syndrome)</strong></p><h4>Clinical presentation</h4><p>It is usually painful and associated with clubbing of the fingers or toes. </p><h4>Pathology</h4><p>The causes of <strong>hypertrophic osteoarthropathy</strong> include</p><ul>- +<p><strong>Hypertrophic osteoarthropathy</strong><em> </em>is 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 <strong>hypertrophic pulmonary osteoarthropathy (HPOA)</strong> and when associated with cancer is considered a <a href="/articles/paraneoplastic-syndromes">paraneoplastic syndrome</a>. </p><h4>Terminology</h4><p>Hypertrophic osteoarthropathy has been referred to with multiple different terms, including: <strong>Pierre-Marie syndrome</strong>, <strong>Bamberger syndrome</strong>, <strong>osteoarthropatia hypertrophica</strong>, <strong>Mankowsky syndrome</strong> and <strong>Hagner syndrome</strong>.</p><h4>Clinical presentation</h4><p>It is usually painful and associated with clubbing of the fingers or toes. </p><h4>Pathology</h4><p>The causes of <strong>hypertrophic osteoarthropathy</strong> include:</p><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>- +<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>Conventional 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>-<strong>Tc <sup>99m</sup> MDP bone scan </strong><ul><li>symmetric linear increase in tracer accumulation along diaphyseal and metaphyseal surfaces of long bones <sup>4</sup>.</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>
- +</li></ul>
-<li><a href="/articles/chronic-venous-insufficiency">chronic venous insufficiency </a></li>- +<li><a href="/articles/chronic-venous-insufficiency">chronic venous insufficiency </a></li>
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Image 5 X-ray (AP) ( update )
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