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.
excellent case
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