Hypertrophic pulmonary osteoarthopathy

Case contributed by Dr 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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Case information

rID: 42358
Published: 18th Jan 2016
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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