July 26, 2012

Concerning bony disorders

A 54 year old man presents with a symmetrical distal arthopathy. On examination he has finger clubbing and a symmetrical arthropathy. Radiography demonstrates visible periosteal new bone formation over the diaphyses of his metacarpals and phalanges.

These features are a recognised complication of:

a) juvenile rheumatoid arthritis
b) scleroderma
c) epidermolysis bullosa
d) bronchial carcinoma
e) infectious mononucleosis

The correct answer is D

Hypertrophic pulmonary osteoarthropathy is often diagnosed radiologically, when a patient presents with a symmetrical distal arthopathy. It is characterised by finger clubbing and a vaguely symmetrical arthropathy, with visible periosteal new bone formation over the diaphyses, but usually not extending to the bone end. There may be hyperaemia.

The condition is thought to be a form of autonomic neuropathy, although the exact mechanism is not fully understood. The more pronounced that a uniform periosteal reaction appears, then the greater likelihood of the patient's having survived long enough to generate it.

In adults, intrathoracic sepsis and carcinoma of the bronchus are the most frequent underlying conditions. Congenital heart disease has an association with HPOA. This and bowel disorders such as Crohn's disease, are more probable in the young as causes of peripheral periosteal reactions.

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