Saturday, November 8, 2014

A 42-year-old man is found to have the following finding on a physical examination (Figure). All of the following conditions are associated with this finding EXCEPT

A 42-year-old man is found to have the following finding on a physical examination (Figure). All of the following conditions are associated with this finding EXCEPT


CLUBBING OF THE FINGER, NOTE THE DRUM STICK PATTERN


A. Chronic obstructive pulmonary disease
B. Cyanotic congenital heart disease
C. Cystic fibrosis
D. Hepatocellular carcinoma
E. Hyperthyroidism

The answer is A. The finding shown in Figure IX-70 is characteristic of clubbing. Clubbing occurs in the distal portions of the digits and is characterized by widening of the fingertips, convexity of the nail contour, and loss of the normal 15° angle between the proximal nail and cuticle.

 Clinically, it sometimes can be difficult to ascertain whether clubbing is present. One approach to the diagnosis of clubbing is to measure the diameter of the finger at the base of the nail and at the tip of the finger in all 10 fingers. For each finger, a ratio between the base of the nail and the tip of the finger is determined. If the sum of all 10 fingers is greater than 1, then clubbing is felt to be present. A simpler approach is to have an individual place the dorsal surfaces of the distal fourth digits from each hand together. In a normal individual, there should be a diamond shaped space between the digits. When an individual has clubbing, this space is obliterated.


Clubbing most commonly occurs in advanced lung disease, especially bronchiectasis, cystic fibrosis, and interstitial lung diseases like sarcoidosis or idiopathic pulmonary fibrosis. Clubbing was originally described in individuals with empyema and can occur in chronic lung infections, including lung abscess, tuberculosis, or fungal infections. Pulmonary vascular lesions and lung cancer also are associated with clubbing. 

However, chronic obstructive pulmonary disease does not cause clubbing. The causes of clubbing are not limited, however, to the pulmonary system alone. Clubbing can be a benign familial condition and is also associated with a variety of other disorders. This includes cyanotic congenital heart disease, subacute bacterial endocarditis,
Crohn’s disease, ulcerative colitis, celiac disease, and cancer of the esophagus, liver, small bowel, and large bowel. In untreated hyperthyroidism clubbing can occur in association with periostitis in a condition called thyroid acropachy. While these numerous clinical associations have been described for many centuries, the cause of clubbing
remains unknown.




0 comments:

Post a Comment