Learning objectives
At the conclusion of this exhibit the radiologist will be able to:
-Describe the imaging findings produced by hypertrophic osteoarthropathy
-Differentiate hypertrophic osteoarthropathy from disease processes that may produce similar radiologic findings
Background
Hypertrophic osteoarthropathy (HOA) is a syndrome characterized by abnormal proliferation of bone and skin.
While a familial primary form of HOA has been described,
95-97% of cases are a secondary to another disease process.
The etiology of secondary HOA is unclear,
however approximately 90% of cases are associated with pulmonary disease,
especially lung cancer.
Associations with pleural,
cardiac,
and gastrointestinal disease have also been shown [1].
Clinical manifestations of HOA include clubbing and swelling of the digits as well as painful swollen joints.
Diagnostic imaging...
Findings and procedure details
Radiographic/CT findings
HOA is characterized by a symmetric periosteal reaction on radiographic examination (Fig. 1 Fig. 2).
This periosteal reaction classically occurs in the long bones such as the tibia,
fibula,
radius and ulna,
although a similar reaction may also occur in the phalanges (Fig. 2).
In the long bones the diaphysis is typically affected first,
with involvement of the metaphysis and epiphysis indicating progression of disease.
Likewise,
the thickness of the reaction is also an indication of advanced disease.
There is typically no abnormality...
Conclusion
HOA is a syndrome that produces characteristic imaging findings on multiple modalities.
However,
similar findings produced by other disease processes may lead to misdiagnosis by the uninformed radiologist.
After viewing this exhibit,
the radiologist will be able to recognize imaging findings specific to HOA and differentiate from other diseases that may mimic these findings,
allowing accurate diagnosis.
References
1. Jajic Z et al.
Primary Hypertrophic Osteoarthropathy: Clinical,
Radiologic,
and Scintigraphic Characteristics.
Archives of Medical Research.
2001; 32:136–142
2.
Martinez-Laven M et al.
Hypertrophic osteoarthropathy: consensus on its definition,
classification,
assessment and diagnostic criteria.
J Rheumatol.
1993; 20(8):1386-7
3.
Joseph B,
Chacko V.
Acro-osteolysis associated with hypertrophic pulmonary osteoarthropathy and pachydermoperiostosis.
Radiology.
1985; 154(2)
4.
Kroon HM et al.
Bone scintigraphy for the detection and follow-up of hypertrophic osteoarthropathy.
Diagnostic Imaging.
1982; 51(1):47-55
5.
Capelastegui A et al.
MR Findings in Pulmonary Hypertrophic Osteoarthropathy....