Secondary Hypertrophic Osteoarthropathy

Thomas F Gudas, MD
Finn Mannting, MD

February 13, 1995

Presentation

Imaging Findings

Bone scintigraphy shows intensely increased activity along the cortices of the long bones in the lower extremities. This creates a double stripe or railroad track appearance. The uptake is slightly asymmetric but does not resemble metastatic disease.

Plain radiography demonstrates periostitis (arrow) in the distal tibial diaphyses. The periosteal bone deposition extends into the metaphyses, with sparing of the epiphyses.

Diagnosis

Discussion

Clinical features include joint swelling and/or pain and clubbing. Resection of the primary tumor in patients with malignancy-related syndromes frequently leads to remission of the signs and symptoms. The bone scan and plain film findings in this patient are classic. Typical sites of involvement include the juxta-articular regions of long bones, phalanges, scapula, clavicle, mandible, maxilla, and patella. The pathogenesis is unknown; neurogenic and vascular etiologies have been proposed.

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