Hypertrophic osteoarthropathy

Case contributed by Dr David Little

Presentation

Bone scan performed for generalized bone pains. History of prostate cancer

Patient Data

Gender: Male

Tc99m Bone Scan

There is patchy peripheral uptake in the tibias bilaterally and to a lesser extend both femurs. The distribution is not typical of metastatic disease. The appearances could be in keeping with hypertrophic osteoarthropathy, differential diagnosis includes venous insufficiency. 

There is a urinary catheter in situ. 

There is a well defined mass in the left upper zone most in keeping with primary bronchogenic malignancy.

Case Discussion

Hypertrophic osteoarthropathy is a syndrome characterized by periosteal reaction of the long bones. It is usually a secondary phenomenon and can be due to a wide range of conditions including pulmonary, gastrointestinal, hematological and inflammatory pathologies. 

In this case, it may be correctly termed 'hypertrophic pulmonary osteoarthropathy' due to the pulmonary etiology but in general, and in exams, this term should be avoided in favor of 'hypertrophic osteoarthropathy' due to broad range of possible etiologies'.

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