April 30, 2010

Hypertrophic Pulmonary Osteoarthropathy (HPOA)


Bone scan image shows diffuse increased uptake along the periosteum/cortical margins of both tibias (arrows), sparing the epiphysis, in this patient with lung cancer.


Facts: HPOA
  • Clinical syndrome that includes clubbing of fingers/toes, periostitis of tubular bones of extremities and arthritis
  • Originally described in association with pulmonary lesions
  • Most commonly associated with pulmonary tumors (10% of cases)
  • Patients can be asymptomatic or present with arthralgia, arthritis or bone pain
  • Histopathology shows edema, mononuclear infiltrates and later osteoid formation of the periosteum
  • Commonly involves long bones of forearms and legs, spared axial skeleton and skull
Imaging
  • Symmetric periostitis along bony shafts, confined to diaphysis; do not involve joint
  • Regular and undulating periosteal reaction
  • On bone scan, there is diffuse increased uptake along the periosteum or cortical margins of long bones with sparing of epiphysis
Disorders Described with HPOA
  • Pulmonary: cancer, metastasis, mesothelioma, infection and bronchiectasis
  • Mediastinum: thymic cancer, thyroid cancer, esophageal leiomyoma, Hodgkin's disease
  • Heart: cyanotic heart disease, bacterial endocarditis
  • Others: liver cirrhosis, inflammatory bowel disease
Reference:

Vigorita VJ, Ghelman B, Mintz D. Orthopaedic Pathology, 2nd edition, 2007.

1 comment:

mazen said...

excellent case

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