title: Hypertrophic Osteoarthropathy: Clinical and Imaging Features.
abstract: Hypertrophic osteoarthropathy (HOA) is a medical condition characterized by abnormal proliferation of skin and periosteal tissues involving the extremities and characterized by three clinical features: digital clubbing (also termed Hippocratic fingers), periostosis of tubular bones, and synovial effusions. HOA can be a primary entity, known as pachydermoperiostosis, or can be secondary to extraskeletal conditions, with different prognoses and management implications for each. There is a high association between secondary HOA and malignancy, especially non-small cell lung cancer. In such cases, it can be considered a form of paraneoplastic syndrome. The most prevalent secondary causes of HOA are pulmonary in origin, which is why this condition was formerly referred to as hypertrophic pulmonary osteoarthropathy. HOA can also be associated with pleural, mediastinal, and cardiovascular causes, as well as extrathoracic conditions such as gastrointestinal tumors and infections, cirrhosis, and inflammatory bowel disease. Although the skeletal manifestations of HOA are most commonly detected with radiography, abnormalities can also be identified with other modalities such as computed tomography, magnetic resonance imaging, and bone scintigraphy. The authors summarize the pathogenesis, classification, causes, and symptoms and signs of HOA, including the genetics underlying the primary form (pachydermoperiostosis); describe key findings of HOA found at various imaging modalities, with examples of underlying causative conditions; and discuss features differentiating HOA from other causes of multifocal periostitis, such as thyroid acropachy, hypervitaminosis A, chronic venous insufficiency, voriconazole-induced periostitis, progressive diaphyseal dysplasia, and neoplastic causes such as lymphoma.©RSNA, 2016.
authors.affiliation: From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.).
authors.forename: Felix Y
authors.identifier: http://orcid.org/0000-0003-1803-2134
authors.initials: FY
authors.lastname: Yap
authors.affiliation: From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.).
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Skalski
authors.affiliation: From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.).
authors.forename: Dakshesh B
authors.initials: DB
authors.lastname: Patel
authors.affiliation: From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.).
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Schein
authors.affiliation: From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.).
authors.forename: Eric A
authors.initials: EA
authors.lastname: White
authors.affiliation: From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.).
authors.forename: Anderanik
authors.initials: A
authors.lastname: Tomasian
authors.affiliation: From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.).
authors.forename: Sulabha
authors.initials: S
authors.lastname: Masih
authors.affiliation: From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.).
authors.forename: George R
authors.initials: GR
authors.lastname: Matcuk
mesh_terms: D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D010004:Osteoarthropathy, Primary Hypertrophic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*