Age / Sex : 54 / M

Chief complaint: incidentally found abnormalities during bone scintigraphy in a patient with lung cancer

Courtesy: 박정미(Jeongmi Park), 가톨릭대여의도성모병원(Yeouido St' Mary's Hospital)

Hypertrophic Osteoarthropathy

Discussion

Findings:

Bone scintigraphy : Slightly increased utpakes in both femoral and
tibial shaft

Plain
radiography: Bilateral symmetric solid periosteal reaction at diaphysis and
metaphysis of femur, tibia and fibula, relatively sparing epiphysis

Differential Diagnosis:

Venous stasis, shin splint, thyroid acropachy, hypervitaminosis A, endosteal
hyperostosis

Diagnosis:
 Hypertrophic
Osteoarthropathy

Discussion:

-      
Formerly known as hypertrophic pulmonary osteoarthropathy, characterized
by digital clubbing and periosteal proliferation along tubular bones.

-      
Bilateral symmetric
periosteal reaction, monolayer to multilayer & shaggy and irregular
excrescences  in severe case

With long standing disease,
involving metaphyses and epiphyses (in primary HOA)  most common involvement in tibia and fibula,
followed by femur, metacarpals, carpus, radius, ulnar, metatarsals and humerus

-      
Pathophysiology;
uncertain, localized vascular proliferation and endosteal cell hyperplasia  in soft tissues, related to one or more
growth factors in systemic circulation that are normally inactivated in the
lungs.

-      
Primary (3-5%)
or secondary (95-97%)

•       Primary
hypertrophic osteoarthropathy (pachydermoperiostosis)

•       Secondary hypertrophic
(pulmonary) osteoarthropathy

-  pulmonary problems that represent a major
cause of periostitis

- 
Disease associated with secondary HOA : bronchogenic cancer, pulmonary

 metaseases, pulmonary abscess, tuberculosis,
cyanotic congenital heart

disease, inflammatory bowel disease,
cirrhosis, esophageal carcinoma

•        Bone scan : technetium-99m (^99m Tc)–labeled diphosphonate

•       earlier than radiographic findings

•       symmetrically increased in the
tubular bones along the cortical margins of the diaphysis and metaphysis

•      
double-stripe
or parallel-track sign

•       correspond well to the clinical
findings.

•       activity decreases with successful
therapeutic measures

•       mandibular
involvement (40%) and scapular involvement (60 %)

Reference:

Imaging of
Musculoskeletal system. P 1611 Pope, Bloem, Beltran, Morrisson, Wilson

Arch Med Res.
Mar-Apr 2001;32(2):136-42