Hypertrophic Pulmonary Osteoarthropathy

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Contents 1 Introduction 2 Etiology 3 Pathology 4 Clinical-manifestations 5 Laboratory 6 Radiology 7 Management 8 More General Terms 9 References

Introduction

• An expansion of long bones, either the distal ends or the entire shafts.

Etiology

• carcinoma of the lung & other malignancies

• adenocarcinoma of the lung
• large cell carcinoma of the lung

• other associated disorders

• chronic pulmonary infections

• cystic fibrosis (severe)
• bronchiectasis

• congenital heart disease with associated hypoxemia

• right to left shunts

• bacterial endocarditis
• sarcoidosis
• pulmonary or intestinal tuberculosis
• myxedema
• amebiasis
• hepatic or biliary cirrhosis
• inflammatory bowel disease
• subphrenic or liver abscess
• aortic aneurysm

Pathology

• erosions of articular cartilage
• thickening & villous proliferation of synovial membranes
• thickened & raised periosteum

Clinical-manifestations

• oligo or polyarthritis

• symmetrical arthralgias
• large joint involvement ( knees, elbows, ankles, wrists)
• synovial effusions, pitting edema

• digital clubbing
• bone pain, tibial tenderness
• alleviation of pain by elevating affected extremities
• gynecomastia
• fever

Laboratory

• increased erythrocyte sedimentation rate (ESR)

Radiology

• periosteal new bone formation at the ends of long bones
• bone scan shows increased uptake of radionuclide by affected periosteum
• chest X-ray may reveal pulmonary lesion

Management

• resection of tumor
• somatostatin analog ( octreotide)
• ipsilateral vagotomy

More General Terms

• osteoarthropathy
• syndrome

References

1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 720-21, 866, 770
3. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998

hypertrophic pulmonary osteoarthropathy (Bamberger-Marie syndrome)