Hypertrophic osteoarthropathy

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[edit] Discussion

  • Hypertrophic osteoarthropathy (HOA) is a clinical syndrome of clubbing of the fingers and toes, enlargement of the extremities, and painful swollen joints.
  • HOA is characterized by symmetric periostitis involving the radius and fibula and, to a lesser extent, the femur, humerus, metacarpals, and metatarsals.
  • The syndrome can be primary or secondary.


  • Primary HOA (aka pachydermoperiostosis) is a rare familial autosomal dominant condition.
  • About 3-5% of patients with HOA have primary HOA.
  • The precise etiology of pachydermoperiostosis is unclear
  • Pachydermoperiostosis usually occurs in adolescents, but it can affect prepubescents as well.



  • In the US: Pachydermoperiostosis is rare
  • HOA occurs in approximately 5% of patients with lung cancer and 50% of patients with pleural mesothelioma.


[edit] Imaging Findings

[edit] Radiographs

  • Pachydermoperiostosis
    • The predominant radiographic periostitis, which is depicted as symmetric osseous thickening.
    • Periostitis mostly affects the tubular bones of the limbs, especially the radius, ulna, tibia, and fibula, although the pelvis, carpus, tarsus, metacarpals, metatarsals, and phalanges can be involved.
    • Periosteal proliferation is usually shaggy and associated with irregular excrescences and diaphyseal expansion.
  • Secondary hypertrophic osteoarthropathy
    • Usually involves diaphyseal and metaphyseal periostitis.
  • Periosteal proliferation is usually single or laminated and regular or irregular.
  • Laminated periostitis may have an onionskin appearance.
  • Periarticular soft tissue swelling, clubbing, and clinical and radiologic features of an underlying primary lesion are often depicted.
  • Digital clubbing associated with soft tissue swelling may be depicted on plain radiographs.

[edit] Nuclear medicine

  • Bone scan with technetium Tc 99m–labeled diphosphonate shows changes of HOA early and with sensitivity greater than that of other methods.
  • Isotope uptake is symmetrically increased in the tubular bones along the cortical margins of the diaphysis and metaphysis.
  • Uptake may be irregular, or it may create a double-stripe or parallel-track sign.
  • Periarticular radionuclide uptake may be increased as a result of associated synovitis.

[edit] Images

Patient #1: Hypertrophic osteoarthropathy in a patient with thymic carcinoma

[edit] See Also

[edit] External Links

[edit] References