What’s the Diagnosis – Case 157
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What’s the Diagnosis – Case 157
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What’s the Diagnosis – Case 157
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Findings At all body parts shown there is a periosteal reaction that predominates in the diametaphyseal location of the bones. The periosteal reaction is fairly thick and without aggressive features (such as a sunburst, hair on end, or Codman triangle architecture). No underlying lesions are present of the bone.
What’s the Diagnosis – Case 157
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What’s the Diagnosis – Case 157
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Diagnosis: Hypertrophic Osteoarthropathy (HPO) Formerly called hypertrophic pulmonary osteoarthropathy because of the most common etiology, the mechanism of this periosteal bone formation is still unknown but thought either related to a neurogenic or humoral pathway. As seen in this case, the findings are a fairly smooth periosteal reaction often with a layered appearance that is present along the diametaphyses of bones. It favors the leg (tibia/fibula), forearm, proximal phalanges, femora, and metacarpals/metatarsals. Patients can present with pain, stiffness, and swelling of the adjacent joints. There is a primary type of hypertrophic osteoarthropathy which is a very rare entity called pachydermoperiostosis where there is associated skin thickening. The secondary form is much more common with the most common underlying etiology related to underlying pulmonary pathology (especially lung cancer as was the portion of the history withheld in this case). The secondary form can be found in a number of inflammatory/infectious processes of the lungs as well as many etiologies involving the GI tract, liver, pancreas, and heart. There is a long differential for periosteal reaction, particularly whether one bone or many are involved. However, given the correct clinical scenario and radiological findings, HPO can often be deduced to be the correct diagnosis.
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References Hypertrophic Osteoarthropathy: Clinical and Imaging Features. Felix Y. Yap, Matthew R. Skalski, Dakshesh B. Patel, Aaron J. Schein, Eric A. White, Anderanik Tomasian, Sulabha Masih, George R. Matcuk, Jr. RadioGraphics. Vol. 37, No. 1 Published Online: Dec 9 2016 https://doi.org/10.1148/rg.2017160052.
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