Pulmonary Hypertrophic Osteoarthropathy

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Abstract
Introduction Although digital clubbing was described by Hippocrates,1 and in 200 AD the relationship of clubbing to chronic diseases was noted,2 it was not until the end of the 19th century that the clinical entity of hypertrophic osteoarthropathy was presented as a clinical and pathological syndrome by Marie,3 in 1890, and Bamberger,4 in 1891. This syndrome, which is referred to as hypertrophic osteoarthropathy, consists of the triad of: (1) periosteal proliferation of the distal ends of the long bones; (2) joint manifestations of swelling, pain, and tenderness; (3) clubbing of the fingers. Although a rare idiopathic form of hypertrophic osteoarthropathy has been described,5 chronic pulmonary disease has been the most frequent cause of osteoarthropathy.6,7 However, these changes have been noted in cases of congenital heart disease with right-to-left shunt and cyanosis 8-11; with pulmonary arteriovenous fistulae 10; with subacute bacterial endocarditis 11; and, less frequently, with chronic liver disease,12,13

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