Hypertrophic Osteoarthropathy With Acro-osteolysis in a Patient With Primary Pulmonary Hypertension

Giraldo, Walter Alberto Sifuentes; Lana, María Ahijón; Rivera, Ignacio Gallego; Bachiller‐Corral, Javier; Gámir, María Luz Gámir

doi:10.1016/j.reumae.2012.06.012

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…A less frequent radiographic pattern, tuftal overgrowth, has also been described in the phalanges, supposedly more commonly in patients with malignancy. However, recent studies have demonstrated considerable overlap between these two patterns (34,35). These two osseous changes usually manifest in the toes first, before the fingers (2).…”

Section: Radiography and Ctmentioning

confidence: 99%

Hypertrophic Osteoarthropathy: Clinical and Imaging Features

Yap¹,

Skalski²,

Patel³

et al. 2017

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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: digital clubbing (also termed Hippocratic fingers), periostosis of tubular bones, and synovial effusions. HOA can be a primary entity, known as pachydermoperiostosis, or can be secondary to extraskeletal conditions, with different prognoses and management implications for each. There is a high association between secondary HOA and malignancy, especially non-small cell lung cancer. In such cases, it can be considered a form of paraneoplastic syndrome. The most prevalent secondary causes of HOA are pulmonary in origin, which is why this condition was formerly referred to as hypertrophic pulmonary osteoarthropathy. HOA can also be associated with pleural, mediastinal, and cardiovascular causes, as well as extrathoracic conditions such as gastrointestinal tumors and infections, cirrhosis, and inflammatory bowel disease. Although the skeletal manifestations of HOA are most commonly detected with radiography, abnormalities can also be identified with other modalities such as computed tomography, magnetic resonance imaging, and bone scintigraphy. The authors summarize the pathogenesis, classification, causes, and symptoms and signs of HOA, including the genetics underlying the primary form (pachydermoperiostosis); describe key findings of HOA found at various imaging modalities, with examples of underlying causative conditions; and discuss features differentiating HOA from other causes of multifocal periostitis, such as thyroid acropachy, hypervitaminosis A, chronic venous insufficiency, voriconazole-induced periostitis, progressive diaphyseal dysplasia, and neoplastic causes such as lymphoma. RSNA, 2016.

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Section: Radiography and Ctmentioning

confidence: 99%

Hypertrophic Osteoarthropathy: Clinical and Imaging Features

Yap¹,

Skalski²,

Patel³

et al. 2017

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Autres affections

Cotten¹,

Petyt²,

Tchernin³

et al. 2013

Imagerie Musculosquelettique : Pathologies Générales

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Hypertrophic osteoarthropathy mimicking a reactive arthritis: a case report and review of the literature

Bozzao

Bernardi

Dore

et al. 2018

BMC Musculoskelet Disord

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BackgroundHypertrophic osteoarthropathy (HOA) is a syndrome characterized by abnormal proliferation of skin and periosteal tissues of the extremities. It can be a rare hereditary disease (pachydermoperiostosis) or can be secondary to various diseases, though mostly lung malignancies. Here, we report an unusual clinical presentation of HOA.Case presentationA 77-year-old man presented with fever, diarrhea, and an oligoarthritis involving the left knee and the ankles. Since left knee synovial fluid aspiration revealed an aseptic synovitis and Clostridium Difficile toxin was detectable in stool samples, a reactive arthritis secondary to a Clostridium Difficile induced colitis was initially suspected. However, the presence of a worsened digital clubbing and the lack of a good clinical response to steroid therapy led us to perform a radionuclide bone scanning, which revealed HOA. This turned out to be associated with a lepidic predominant lung adenocarcinoma, which was clinically and radiologically difficult to distinguish from a relapse of pneumonia.ConclusionConsistent with the literature, HOA tends to have a variable clinical presentation, mimicking that of various rheumatic diseases. This clinical case shows that HOA can present as a presumptive acute reactive arthritis, and it highlights the importance of patient’s follow-up in the differential diagnosis of inflammatory arthritis, especially when a worsened digital clubbing is present.

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Hypertrophic Osteoarthropathy With Acro-osteolysis in a Patient With Primary Pulmonary Hypertension

Cited by 3 publications

References 14 publications

Hypertrophic Osteoarthropathy: Clinical and Imaging Features

Hypertrophic Osteoarthropathy: Clinical and Imaging Features

Autres affections

Hypertrophic osteoarthropathy mimicking a reactive arthritis: a case report and review of the literature

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