Hypertrophic pulmonary osteoarthopathy

Case contributed by Matt Andrews


4 month history of arthralgia. Past medical history withheld.

Patient Data

Age: 30
Gender: Male

Bilateral wrist radiographs


There is extensive well-defined multilayered periosteal reaction involving the radius, ulnar, metacarpal bones, and visualized phalanges of both wrists / hands. The bones are generally diffusely osteopaenic. No evidence of fracture, or destructive osseous lesion. There is no joint space narrowing or erosions. No abnormal soft tissue calcification

Bilateral ankle radiographs


Extensive well-defined multilayered periosteal involving the distal tibia and fibula on either side. The ankle joints are intact. No evidence of fracture or dislocation, and no destructive osseous lesion. No joint space narrowing or erosions

Chest radiograph


There is loss of volume in the left hemithorax with extensive pleural thickening. 

Case Discussion

This case provides a good example of bilateral, confluent periosteal reaction seen in hypertrophic osteoarthropathy. The patient had a known history of pulmonary TB, hence in this case the term hypertrophic pulmonary osteoarthopathy (HPOA) may be used.

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