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Hypertrophic osteoarthropathy
Dr Yuranga Weerakkody and Dr Frank Gaillard et al.

Hypertrophic osteoarthropathy is characterised by a proliferative periostisis involving the long bones. When
associated with a lung condition it is also termed hypertrophic pulmonary osteoarthropaty (HPOA). It is usually
painful and associated with clubbing

The causes of hypertrophic osteoarthropathy include :

bronchogenic carcinoma : non small cell lung cancer is the strongest malignant association
pulmonary lymphoma
lung abscess
bronchiectasis
pulmonary metastases (esp. from osteosarcoma)
pleural fibroma
mesothelioma
cyanotic congenital heart disease
inflammatory bowel disease
gastrointestinal lymphoma
Whipple disease
coeliac disease
primary biliary cirrhosis
pachydermoperiostosis
thyroid acropachy
familial
idiopathic

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Radiographic features

Plain film

Typically seen as a long metaphyseal and diaphyseal smooth periosteal reaction involving the long bones.

With disease progression, periostitis becomes more prominent or multilayered, and extends to the epiphyses1.

Differential diagnoses

Consider the differential for a smooth periosteal reaction.

References
1. Pineda CJ, Martinez-lavin M, Goobar JE et-al. Periostitis in hypertrophic osteoarthropathy: relationship to
disease duration. AJR Am J Roentgenol. 1987;148 (4): 773-8. AJR Am J Roentgenol (abstract) - Pubmed
citation
2. Angel-moreno maroto A, Martínez-quintana E, Suárez-castellano L et-al. Painful hypertrophic
osteoarthropathy successfully treated with octreotide. The pathogenetic role of vascular endothelial growth factor
(VEGF). Rheumatology (Oxford). 2005;44 (10): 1326-7. doi:10.1093/rheumatology/keh720 - Pubmed citation

Synonyms & Alternative Spellings

Synonyms or Alternative Spelling Include in Listings?
HPOA ✓
hypertropic pulmonary osteoarthropathy ✗
hypertropic pulmonary osteoarthropathy (HPOA) ✗
HOA ✗
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Article Information:
System: Musculoskeletal
Section: Gamuts

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Case 1
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Case 2
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Imaging Differential Diagnosis

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Chronic venous stasis

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