[Differential diagnosis of osteoarthropathia hypertrophicans].

Abstract

PURPOSE:

Chief clinical symptoms of HOA are bone and joint plain, nearly always coupled with finger and toe clubbing. The classification of HOA distinguishes between a very seldom primary (PHOA) and the more frequent secondary hypertrophic osteoarthropathy (SHOA). The pathogenesis of the disease is as yet not wholly understood, but there is a tendency that it may be a bony manifestation of a paraneoplastic syndrome.

RESULTS:

By means of two cases, one a 72-year old patient with pulmonary carcinoma, the second a 48-year-old patient with a long standing history of COPD, we demonstrate and discuss typical clinical, laboratory, radiographic, and scintigraphic findings associated with SHOA. Primarily the patients consulted an orthopaedic surgeon due to persisting, localised osseous pain. Clubbing of fingers and toes as well as soft tissue swelling usually remain asymptomatic. Characteristically a symmetrical diaphyseal accumulation of periosteal calcification in the vicinity of short and long cortical bones becomes radiographically apparent. Early diagnosis is best facilitated by means of a bone scan, where the symmetrical increase in bone activity and the typical "double stripe sign" can be observed.

CONCLUSION:

In patients in whom unexplained periosteal reaction is found and phalangeal clubbing becomes evident, the diagnosis of SHOA should be contemplated and further tests performed, so as to rule out a paraneoplastic syndrome.

• Authors: O Diedrich, J M Meyer, L Perlick, C N Kraft
• Journal: Zeitschrift fur Orthopadie und ihre Grenzgebiete (Z Orthop Ihre Grenzgeb) 2001 Mar-Apr Vol. 139 Issue 2 Pg. 168-73 ISSN: 0044-3220 [Print] Germany
• Vernacular Title: Differentialdiagnose der Osteoarthropathia hypertrophicans (HOA).
• PMID: 11386109 (Publication Type: Case Reports, English Abstract, Journal Article)

Topics

• Aged
• Bone and Bones (pathology)
• Carcinoma, Squamous Cell (complications, diagnosis, pathology)
• Diagnostic Imaging
• Female
• Humans
• Lung Diseases, Obstructive (complications, diagnosis, pathology)
• Lung Neoplasms (complications, diagnosis, pathology)
• Male
• Middle Aged
• Osteoarthropathy, Secondary Hypertrophic (diagnosis, etiology, pathology)
• Paraneoplastic Syndromes (diagnosis, etiology, pathology)