Case 21 :

45 year old male for a follow up radiograph after ankle surgery. What is the diagnosis?

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Hypertrophic (Pulmonary) osteoarthropathy.

Imaging Diagnosis

Exhuberant periostitis is seen along the shafts of tibia and fibula and also along metatarsal diaphysis.
Hand radiograph taken subsequently showed similar periosteal reaction.

Chest radiographs were also taken revealed a large mass in the right lower lobe which on biopsy was adenocarcinoma

Though traditionally called hypertrophic pulmonary osteoarthropathy, we all know the condition can be caused by nonpulmonary conditions like Cirrhosis of liver, infective endocarditis and inflammatory bowel disease. Theories proposed for development are neurovascular abnormality in the soft tissues of hands and feet. Typicaaly presents clinically with soft tissue swellinf of hands and feet and clubbing of digits. Radiologically there is soft tissue swelling, periosteal reaction in metadiaphyseal regions with relative sparing of epiphyseal regions. Typically distal tibia- fibula and radius ulna are involved along with metacarpal and metatarsal involvement. Radionuclide bone scan can delineate lesions very well.



Dr Paresh Desai, Goa

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