Finger clubbing - cyanotic heart disease (MRI)

Case contributed by Dr Dalia Ibrahim

Presentation

Bilateral diffuse fingernail swelling.

Patient Data

Age: 20 years

Soft tissue edema and thickening under the nail bed eliciting low T1 signal and high signal on T2 & STIR WI.

Soft tissue edema and thickening under the nail bed eliciting low T1 signal and high signal on T2 & STIR WI.

Photo of the patient's hand demonstrates typical finger clubbing.

Case Discussion

The patient has longstanding cyanotic heart disease.

Finger clubbing also called "drumstick fingers", is a common clinical sign in patients with heart or lung disease. The term is used to describe an enlargement of the distal phalanges of the fingers, giving them a drumstick or club-like appearance. 

It has a number of causes including pulmonary or cardiac diseases, gastrointestinal diseases, and thyrotoxicosis.

Finger clubbing is caused by increased proangiogenic factors including vascular endothelial growth factor which leads to tissue hypertrophy under the nail bed leading to elevation of the nail bed associated with soft tissue edema evaluated on MRI imaging.

This case is courtesy of Dr Ahmed Hossam.

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