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Figure 1. Clubbing and Hypertrophic Osteoarthropathy.
On examination the hands of a 70-year-old woman with worsening cough and pretibial pain show digital clubbing (Panel A). The terminal phalanges are enlarged, and there is loss of the normal nail-to-cuticle angle. A radiograph of the tibia and fibula (Panel B) shows the characteristic periosteal elevation of hypertrophic osteoarthropathy. A chest radiograph (Panel C) shows hyperinflation, borderline cardiac enlargement, and a left hilar mass that proved to be a non-small-cell bronchogenic carcinoma.
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