Clubbing: Difference between revisions
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==Background== | ==Background== | ||
*Painless enlargement of terminal phalangeal connective tissue | |||
*Affects fingers > toes | |||
*Increased vascular connective tissue proliferation | |||
**May be due to megakaryocyte escaping from lungs due to damaged pulmonary capillaries, travelling to distal capillaries, and subsequently releasing growth factors +/- increased PGE2 | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:ClubbingFingers1.jpg|thumb|]] | [[File:ClubbingFingers1.jpg|thumb|]] | ||
[[File:Dedos con acropaquia.jpg|thumb|]] | |||
[[File:CongenitalHeartCase-133.jpg|thumb|Digital clubbing with cyanotic nail beds in an otherwise healthy-appearing, asymptomatic young adult with Tetralogy of Fallot.]] | |||
*Bulbous enlargement of the ends of one or more fingers or toes | |||
*Loss of the normal angle between the skin and nail plate and excessive sponginess of the nail base | |||
*Frequently accompanied by cyanosis of the nail bed | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Clubbing as a sign can be related to the following causes: | |||
*Respiratory Conditions | |||
**Interstitial fibrosis | |||
**Bronchiectasis | |||
**[[Lung cancer]] | |||
**[[Empyema]] | |||
**[[Cystic fibrosis]] | |||
*Other Systemic Conditions | |||
**Cyanotic [[congenital heart disease]] | |||
**[[Endocarditis]] | |||
**[[Liver cirrhosis]] | |||
**Chronic [[diarrhea]] | |||
*Hereditary | |||
*Idiopathic | |||
==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
*Evaluate potential underlying conditions as above based on clinical context | |||
**CXR | |||
**CT Chest | |||
**ABG / VBG | |||
**Pulse oximetry | |||
**CMP | |||
**Echocardiogram | |||
===Diagnosis=== | ===Diagnosis=== | ||
*Hyponychial angle >190 degrees | |||
*Schamroth Sign - absent window between proximal nailbeds when opposite fingers placed back to back indicates clubbing | |||
==Management== | ==Management== | ||
*Treatment of underlying condition can improve findings over time | |||
==Disposition== | ==Disposition== | ||
*Based on overall clinical stability and other underlying diagnoses | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
1. McGee S. Chapter 28: Inspection of the Chest. In: Evidence-Based Physical Diagnosis. 5th ed. Philadelphia, PA: Elsevier; 2022. p. 235–9. | |||
[[Category:Symptoms]] | |||
Latest revision as of 18:28, 29 January 2025
Background
- Painless enlargement of terminal phalangeal connective tissue
- Affects fingers > toes
- Increased vascular connective tissue proliferation
- May be due to megakaryocyte escaping from lungs due to damaged pulmonary capillaries, travelling to distal capillaries, and subsequently releasing growth factors +/- increased PGE2
Clinical Features
- Bulbous enlargement of the ends of one or more fingers or toes
- Loss of the normal angle between the skin and nail plate and excessive sponginess of the nail base
- Frequently accompanied by cyanosis of the nail bed
Differential Diagnosis
Clubbing as a sign can be related to the following causes:
- Respiratory Conditions
- Interstitial fibrosis
- Bronchiectasis
- Lung cancer
- Empyema
- Cystic fibrosis
- Other Systemic Conditions
- Cyanotic congenital heart disease
- Endocarditis
- Liver cirrhosis
- Chronic diarrhea
- Hereditary
- Idiopathic
Evaluation
Workup
- Evaluate potential underlying conditions as above based on clinical context
- CXR
- CT Chest
- ABG / VBG
- Pulse oximetry
- CMP
- Echocardiogram
Diagnosis
- Hyponychial angle >190 degrees
- Schamroth Sign - absent window between proximal nailbeds when opposite fingers placed back to back indicates clubbing
Management
- Treatment of underlying condition can improve findings over time
Disposition
- Based on overall clinical stability and other underlying diagnoses
See Also
External Links
References
1. McGee S. Chapter 28: Inspection of the Chest. In: Evidence-Based Physical Diagnosis. 5th ed. Philadelphia, PA: Elsevier; 2022. p. 235–9.