This is the first report of a super scan due to pulmonary hypertrophic osteoarthropathy which can be seen in lung carcinoma and other pulmonary diseases. The painful osteoarthropathy had made the patient incapacitated. The clinical data of 6,151 patients with advanced lung. The differential diagnosis for this pattern of bilateral periosteal reaction includes hypertrophic pulmonary osteoarthropathy hoa, pachydermoperiostosis. Hypertrophic pulmonary osteoarthropathy without clubbing of the digits. Hypertrophic osteoarthropathy is a medical condition, which affects the joints and the bones of the body. To access and investigate a middleaged nonsmoking male who presented rheumatoid arthritis with swelling and pain in bilateral knees, and clubbing. Hypertrophy of the feet and ankles presenting in primary hypertrophic osteoarthropathy or pachydermoperiostosis.
This means that the extremities become enlarged, leading to the appearance of pain and inflammation specifically at the level of the joints. Hypertrophic osteoarthropathy hoa is an uncommon condition in children, consisting of a triad of digital clubbing, noninflammatory joint effusions and radiographic evidence of periostitis affecting the hands, feet and distal long bones. Pulmonary hypertrophic osteoarthropathy and its resolution. Division of pediatric radiology, department of radiology, university of washington school of medicine and seattle childrens hospital, seattle, wa. Pulmonary hypertrophic osteoarthropathy jama jama network. Hypertrophic osteoarthropathy in children is rare and is typically considered to be a sign of pulmonary disease. The exact pathogenic mechanism is unknown, but periosteal vascularity is reduced. Know the types, causes, symptoms, pathophysiology and treatment of. Although not common, ho has been reported in lizards. This clinical triad of digital clubbing, arthralgias, and ossifying periostitis has been recognized since the late 1800s and was previously known as hypertrophic pulmonary osteoarthropathy hpoa. Medium lv failure, pulmonary oedema coarse gurgling bronchiectasis expiratory fibrosis pulmonary oedema does not clear with coughing wheezes high pitched sibilant narrowed ariways smaller higher pitch asthma low pitched sonorous secretions in. Hypertrophic pulmonary osteoarthropathy hpoa is a syndrome characterized by the triad of periostitis, digital clubbing and painful arthropathy of the large joints, especially involving the lower limbs. What hypertrophic pulmonary osteoarthropathy hpoa is. Packard1 and published in the american journal of medical sciences.
Pulmonary pathology has been associated with this condition in greater than 90% of the cases. Original article from the new england journal of medicine pulmonary hypertrophic osteoarthropathy periostitis its absence in pulmonary tuberculosis. Hypertrophic osteoarthropathy in untreated ulcerative. Full text get a printable copy pdf file of the complete article 1. I have chosen this symptom group for description as it is one that has received little attention from american writers. Open access publication the foot and ankle online journal. Hypertrophic pulmonary osteoarthropathy hpoa hypertrophic pulmonary osteoarthropathy is a condition that affects some people with lung cancer.
Below are the links to the authors original submitted files for images. Hpoa is a group of symptoms that can affect the organs, lungs, bones and joints. Palliative care rounds hypertrophic pulmonary osteoarthropathy. Hoa can also be associated with pleural, mediastinal, and cardiovascular causes, as well as extrathoracic conditions such as gastrointestinal tumors and. University of washington, school of medicine, seattle, wa. Distal expansion of the long bones as well as painful, swollen joints. Its etiology and mechanism, however, remain to be elucidated. References to any names, marks, products, or services of third. Two patients with hypertrophic osteoarthropathy of unusual aetiology are described. We describe a case of 23yearold man, who presented with painful hypertrophic pulmonary osteoarthropathy involving bilateral upper and lower extremities, resulting from intrathoracic metastasis. Hypertrophic osteoarthropathy can be defined as a medical condition in which the bones and the joints are affected. Hpoa without clubbing of the digits is considered an incomplete form of hpoa and has been rarely reported. We present a case of a patient diagnosed with nonsmall cell lung cancer and hoa suffering from. The paradox that clubbing of the fingers usually occurs with pulmonary hypertrophic osteoarthropathy, though most instances of clubbed fingers are not associated with osteoarthropathy, should halt those physicians who have adopted the grandiose but misleading habit of referring to clubbing of the fingers as pulmonary hypertrophic osteoarthropathy.
The incidence of hypertrophic pulmonary osteoarthropathy for the total group of cases, including both benign and malignant primary lung tumors as well as tumors metastatic to the lung, was 9. Hypertrophic osteoarthropathy clinical presentation. In coexistent lung cancer with pulmonary tuberculosis. Hypertrophic osteoarthropathy and childhood hodgkin disease. Hypertrophic pulmonary osteoarthropathy medical symptom. In the second case, substantial resorption of new bone was seen following treatment. There are only a few reports of secondary hoa with crohns disease. The association of digital clubbing with several pulmonary diseases, including diffuse interstitial fibrosis dif, is well established 1. Medium lv failure, pulmonary oedema coarse gurgling bronchiectasis expiratory fibrosis pulmonary oedema does not clear with coughing wheezes high pitched sibilant narrowed ariways smaller higher pitch asthma low pitched sonorous secretions in the airways eg. Medication induced periostitis resembling hypertrophic.
Hypertrophic osteoarthropathy with acroosteolysis in a patient with. The idiopathic form named pachydermoperiostosis, primary hypertrophic osteoarthropathy or tourainesoulentegole syndrome is a rare disease, with unknown etiology, and represents 3 to 5% of all cases of hypertrophic osteoarthropathy. Primary hypertrophic osteoarthropathy is a rare condition. Hypertrophic osteoarthropathy manifests as digital clubbing, subperiosteal new.
Hypertrophic osteoarthropathy hoa is a medical condition characterized by abnormal proliferation of skin and periosteal tissues involving the extremities and characterized by three clinical features. Pulmonary hypertrophic osteoarthropathy jama internal. The primary change in the limbs of patients with pulmonary hypertrophic osteoarthropathy is an overgrowth of vascular connective tissue investing the structures in the distal part of the limb. Approximately 90% of these cases have an underlying malignancy. Bone scan above left shows symmetric, bilateral, linear uptake in the femurs and tibias black arrows while the conventional radiographs of the distal femurs and proximal tibias above right show smooth, wavy periosteal reaction primarily involving the metadiaphyseal portion of the bones white arrows. Hypertrophic pulmonary osteoarthropathy in a lioness. Lung transplant, pulmonary osteoarthropathy, medication related bone changes doi. Hypertrophic pulmonary osteoarthropathy sciencedirect. It was introduced in the late 1800s and was believed to be a pulmonary disease manifestation known as hypertrophic pulmonary osteoarthropathy hpoa 1. Paraneoplastic hypertrophic pulmonary osteoarthropathy and pain. Although a rare idiopathic form of hypertrophic osteoarthropathy has been described, 5 chronic pulmonary disease has been the most frequent cause of osteoarthropathy. Baumrucker, md, faafp, faahpm, ahmed alsheyyab, md, and.
There are a broad range of manifestations, although typically there is symmetrical involvement of the appendicular skeleton. Hypertrophic osteoarthropathy is a medical condition combining clubbing and periostitis of the. Developed by renowned radiologists in each specialty, statdx provides comprehensive decision support you can rely on hypertrophic osteoarthropathy. Hypertrophic pulmonary osteoarthropathy diseases of the. The patients with hypertrophic pulmonary osteoarthropathy.
However, hoa in inflammatory bowel disease is a rare complication. We report the case of a 30yearold man diagnosed with primary pulmonary hypertension for two years, developing hypertrophic osteoarthropathy with a mixed. Hypertrophic osteoarthropathy hypertrophic pulmonary osteoarthropathy hypertrophic osteoarthropathy is a disorder characterized by bilateral symmetrical subperiosteal new bone formation at the ends of long bones. Hypertrophic pulmonary osteoarthropathy hpo can be differentiated from osseous metastasis on conventional bone images using technetium 99m. Diffuse skeletal metastasis of a welldifferentiated prostate carcinoma is unlikely to be the cause of a super scan when the prostate specific antigen level is not elevated. Hypertrophic osteoarthropathy hoa is a medical condition char. Hypertrophic osteoarthropathy causes, diagnosis, treatment. Distal expansion of the long bones as well as painful, swollen joints and synovial villous proliferation are often seen. Usually it occurs in patients with pulmonary inflammatory disease cystic fibrosis, bronchiectasia, obstructive bronchitis, but it also has been described in patients with malignancies, heart disease, and rarely in patients with ibd and celiac disease 5,710,12. After admission, auxiliary equipment inspection was performed. Hy pertrophic pulmonary osteoarthropathy re vealed by a pulmonary epithelioid hemangio endothelioma in a 15yearold girl. Hypertrophic osteoarthropathy radiology reference article.
Symmetrical osteitis of the four limbs, chiefly localized to the phalanges and the terminal epiphyses of the long bones of the forearm and leg, sometimes extending to the proximal ends of the limbs and the flat bones, and accompanied by dorsal kyphosis and joint involvement. In a patient with chronic lung disease, the findings are in keeping with hypertrophic osteoarthropathy, and would explain the patients chronic pain. Hypertrophic pulmonary osteoarthropathy hpoa or else. In hypertrophic osteoarthropathy, the toes and fingers go through a process which is termed as clubbing, where there is enlargement of the extremities resulting in inflammation and pain, especially at the joint level. Hypertrophic pulmonary osteoarthropathy hpoa pierre marie. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. S ir, hypertrophic pulmonary osteoarthropathy hpoa is a syndrome defined by digital clubbing and distal periostitis in tubular bones. Secondary hoa previously referred to as hypertrophic pulmonary osteoarthropathy is most commonly associated with primary lung malignancies, particularly nonsmall cell lung carcinoma.
Hypertrophic osteoarthropathy hoa is a clinical syndrome of clubbing of the fingers and toes, enlargement of the extremities, and painful, swollen joints. Most commonly but not exclusively, the condition is associated with destructive chronic lung disease or lung tumors. Recognising and treating it accordingly will reduce the symptom burden of patients. Hypertrophic osteoarthropathy in a child due to thoracic hodgkins. Patients with secondary hypertrophic osteoarthropathy usually complain of pain and swelling in joints and long bones, and clubbing of fingers. The primary change in the limbs of patients with pulmonary hypertrophic osteoarthropathy is an overgrowth of vascular connective tissue investing the structures in the. The management and prognosis of hoa is dependent on the underlying disease process. Hypertrophy of the feet and ankles presenting in primary. Examples of osteoarthropathy from diverse causes are presented includ. Hypertrophic osteoarthropathy is a syndrome characterized by periosteal reaction of the long bones without underlying bone lesion. Pulmonary hypertrophic osteoarthropathy definition of. Open access publication hypertrophic osteoarthropathy and digital clubbing in lung adenocarcinoma by konstantinos michalakis, md 1 dimitriosanestis moutzouris, md2 the foot and ankle online journal 2 7. Hypertrophic osteoarthropathy is an osteopetrosis variant that occurs secondary to other disease processes, including chronic obstructive pulmonary disease, lung cancer,308 bronchiectasis, pulmonary fibrosis, congenital heart disease, liver cirrhosis, cystic fibrosis,309 chronic gastrointestinal disease, renal tubular acidosis,310 cystic fibrosis, multiple myeloma,311 and other chronic diseases. It is a rare syndrome, so there is not much information about it.
Hypertrophic osteoarthropathy hoa is a syndrome that consists of periostitis, digital clubbing, and painful polyarthropathy. Treatment of painful hypertrophic osteoarthropathy associated with nonsmall cell lung cancer with octreotide. Hypertrophic osteoarthropathy hoa can result in widespread periostitis in the skeleton, and occurs in adults and children. Table 3 shows the mean ages of all patients in both the primary and metastatic tumor groups. Hypertrophic pulmonary osteoarthropathy an overview. Hypertrophic osteopathy in dogs symptoms, causes, diagnosis. Over 10 million scientific documents at your fingertips.
Pulmonary osteoarthropathy definition of pulmonary. Hypertrophic osteoarthropathy manifests as digital clubbing, subperiosteal new bone formation in tubular bone and diffuse skin hypertrophy. Hypertrophic osteopathy has not only been found in humans and dogs but also in horses, cows, sheep, cats, fowl and other species of animals. Hypertrophic pulmonary osteoarthropathy with primary lung cancer. Commonly, secondary osteoarthropathy accompanies pulmonary diseases such as carcinoma of the lung, pleural tumors, lung abscesses, and bronchiectasis.
Accompanying abnormal soft tissue proliferation is variable and may result in clubbing of. Hypertrophic osteopathy in dogs is defined as an abnormal growth of soft the tissue periosteum which lines the outside of the long bones in dogs, generally being secondary to neoplastic or infectious masses of the abdominal or thoracic cavity. Pulmonary osteoarthropathy description of pulmonary osteoarthropathy. It is associated with a number of medical conditions, mainly lung cancer, congenital cyanotic heart disease and other systemic illnesses with pulmonary. Hypertrophic osteoarthropathy symptoms, treatments. Treatment of hypertrophic osteoarthropathy with underlying pulmonary adenocarcinoma using zoledronic acid. Isotope bone scanning with technetium99m 99m tclabeled diphosphonate shows evidence of hypertrophic pulmonary osteoarthropathy hpoa early in the course of disease. It has also been referred to as hypertrophic pulmonary osteoarthropathy because the underlying disease has most often been found to be pulmonary in nature. Hypertrophic osteoarthropathy hoa is a syndrome of clubbing of the digits, periostitis of the long tubular bones, and arthritis. Pdf hypertrophic osteoarthropathy in patient with crohn. Hypertrophic osteoarthropathy hoa is a syndrome characterized by clubbing of the fingers and toes, periosteal new bone formation of the long bones and polyarthritis. All structured data from the file and property namespaces is available under the creative commons cc0 license. Hypertrophic osteoarthropathy is a very rare cause of acute pain in a limb.
A case is reported of hypertrophic osteoarthropathy as the presenting feature of pulmonary metastases from renal carcinoma, and of its relief by pulmonary resection. A rare but treatable condition in palliative medicine mehdi pourmorteza, do, steven j. Treatment of hypertrophic osteoarthropathy in the case of. It has been my fortune to find but one case described in the literature of this country.
There are a broad range of manifestations, although typically there is symmetrical involvement of the append. Painful hypertrophic osteoarthropathy successfully treated. We report a 31yearold man presenting with digital clubbing and diffuse skin thickening which started at puberty. Definition csp two types, primary type is a condition chiefly characterized by thickening of the skin of the head and distal extremities, deep folds and furrows of the skin of the forehead, cheeks, and scalp, seborrhea, hyperhidrosis, periostosis of the long bones, digital clubbing, and spadelike enlargement of the hands and feet, it is more prevalent in the male. Jan 08, 2018 hypertrophic osteoarthropathy hoa is a syndrome of clubbing of the digits, periostitis of the long tubular bones, and arthritis. Case report hypertrophic osteoarthropathy secondary to. Dec 06, 2015 possible causes of hypertrophic pulmonary osteoarthropathy medical symptom hypertrophic pulmonary osteoarthropathy is a medical condition combining clubbing and periostitis of the small hand. Paraneoplastic hypertrophic pulmonary osteoarthropathy and. Hypertrophic osteopathy is a diffuse periosteal proliferative condition of long bones in dogs secondary to neoplastic or infectious masses in the thoracic or abdominal cavity. Hypertrophic osteopathy in small animals musculoskeletal. Hypertrophic pulmonary osteoarthropathy hpo is a rare paraneoplastic syndrome that is frequently associated with lung cancer.
The first patient developed the condition in association with oesophageal carcinoma and the second as a complication of active pulmonary tuberculosis. Hypertrophic osteoarthropathy in a child with chronic liver. Learningradiology hypertrophic, osteoarthropathy, hoa, hpo. Clinical signs include lameness, longbone pain, and signs secondary to body cavity masses. Images with significant changes post lung tumor resection. Numerous causes of hypertrophic osteoarthropathy hoa have been reported. The most common causes of the condition are pulmonary tuberculosis. Much knowledge regarding the clinical aspects of hypertrophic osteoarthropathy has been acquired in the past half century. Files are available under licenses specified on their description page. Bonescan of a person with hypertrophic osteoarthropathy. Secondary hypertrophic osteoarthropathy is associated with many illnesses. Hypertrophic osteopathy has been known as hypertrophic pulmonary osteopathy, hypertrophic pulmonary osteoarthropathy, 26 and hypertrophic osteoarthropathy. Basically, the finger and toes suffer from a process that is known as clubbing.
Hypertrophic pulmonary osteoarthropathy and its occurrence. What links here related changes upload file special pages permanent. Hypertrophic pulmonary osteoarthropathy definition of. Apr 02, 2014 hypertrophic pulmonary osteoarthropathy hpo is a rare paraneoplastic syndrome that is frequently associated with lung cancer. Sep 28, 2006 we report the cases of two middleaged male smokers who presented to the early synovitis clinic with an acute phase response, synovitis of the wrists and ankles and clubbing of the fingers, but no respiratory symptoms. Pulmonary hypertrophic osteoarthropathy periostitis its. The two prevailing theories for the pathophysiology of neuropathic bone and joint disease, the neurovascular and neurotraumatic theories, are briefly described. Other names, hypertrophic pulmonary osteoarthropathy, bambergermarie syndrome, osteoarthropathia hypertrophicans.
Both proved to have primary lung tumours with hypertrophic pulmonary osteoarthropathy, in one case resolving promptly with treatment of the carcinoma. The most prevalent secondary causes of hoa are pulmonary in origin, which is why this condition was formerly referred to as hypertrophic pulmonary osteoarthropathy. Clinical signs include lameness, longbone pain, and signs secondary to body cavity. Hypertrophic pulmonary osteoarthropathy secondary to bronchial. Pdf hypertrophic osteoarthropathy in association with. Hypertrophic osteoarthropathy and digital clubbing dermnet nz. The patient had a history of undifferentiated nasopharyngeal carcinoma which was treated successfully 2 years ago.
A distinction is to be made between simple clubbing of the fingers and osteoarthropathy. Pdf hypertrophic pulmonary osteoarthropathy with primary. Pulmonary hypertrophic osteoarthropathy, spider angiomata, and estrogen. Hypertrophic pulmonary osteoarthropathy hpoa is a syndrome characterized by the triad of periostitis, digital clubbing and painful arthropathy. Hypertrophic pulmonary osteoarthropathy hpoa lung cancer. Hypertrophic osteoarthropathy and digital clubbing. Secondary hypertrophic osteoarthropathy associated with. Case report hypertrophic osteoarthropathy secondary to thymoma.
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