Images in Clinical Medicine

Kim Eagle, M.D., Editor

Clubbing and Hypertrophic Osteoarthropathy

Melvin D. Burton, M.D., and John C. Wain, Jr., M.D.

N Engl J Med 1993; 329:1861December 16, 1993

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Article

Figure 1 Clubbing and Hypertrophic Osteoarthropathy.

On examination the hands of a 70-year-old woman with worsening cough and pretibial pain show digital clubbing (Panel A). The terminal phalanges are enlarged, and there is loss of the normal nail-to-cuticle angle. A radiograph of the tibia and fibula (Panel B) shows the characteristic periosteal elevation of hypertrophic osteoarthropathy. A chest radiograph (Panel C) shows hyperinflation, borderline cardiac enlargement, and a left hilar mass that proved to be a non-small-cell bronchogenic carcinoma.

Kim Eagle, M.D.

Melvin D. Burton, M.D.
John C. Wain, Jr., M.D.
Massachusetts General Hospital, Boston, MA 02114