[Differential diagnosis of osteoarthropathia hypertrophicans].

PURPOSE: Chief clinical symptoms of HOA are bone and joint plain, nearly always coupled with finger and toe clubbing. The classification of HOA distinguishes between a very seldom primary (PHOA) and the more frequent secondary hypertrophic osteoarthropathy (SHOA). The pathogenesis of the disease is as yet not wholly understood, but there is a tendency that it may be a bony manifestation of a paraneoplastic syndrome.

RESULTS

By means of two cases, one a 72-year old patient with pulmonary carcinoma, the second a 48-year-old patient with a long standing history of COPD, we demonstrate and discuss typical clinical, laboratory, radiographic, and scintigraphic findings associated with SHOA. Primarily the patients consulted an orthopaedic surgeon due to persisting, localised osseous pain. Clubbing of fingers and toes as well as soft tissue swelling usually remain asymptomatic. Characteristically a symmetrical diaphyseal accumulation of periosteal calcification in the vicinity of short and long cortical bones becomes radiographically apparent. Early diagnosis is best facilitated by means of a bone scan, where the symmetrical increase in bone activity and the typical "double stripe sign" can be observed.

CONCLUSION

In patients in whom unexplained periosteal reaction is found and phalangeal clubbing becomes evident, the diagnosis of SHOA should be contemplated and further tests performed, so as to rule out a paraneoplastic syndrome.