Pachydermoperiostosis Workup

  • Author: Supriya Goyal, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Dec 5, 2011
 

Laboratory Studies

Thyrotropin and growth hormone levels should be examined to exclude thyroid acropachy and acromegaly. Reactive plasma reagent and Venereal Disease Research Laboratory testing should be performed to check for syphilitic periostosis.

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Imaging Studies

Radiographs of the long bones reveal subperiosteal new bone formation, which is a characteristic radiologic feature. This feature is mainly seen in the distal tibia, the fibula, the radius, the ulna, the metacarpals, the phalanges, and, less frequently, the metatarsals. Acro-osteolysis and ossification of the ligaments and interosseus membranes may also occur.[27, 28]

Other radiographic abnormalities include the following[29] :

  • Patients may develop cortical thickening without narrowing of the medullary cavity.
  • Enlargement of the paranasal sinuses is reported.

Radionucleotide bone imaging (bone scanning) findings in patients with pachydermoperiostosis or primary hypertropic osteoarthropathy demonstrate increased radiopharmaceutical uptake in the diaphyses and the metaphyses of long bones along the cortical margins.[30, 29]

  • Uptake may result from hyperemia occurring prior to subperiosteal proliferation.
  • Periarticular regions may also have increased uptake because of associated synovitis.
  • Scintigraphic findings (such as those described above) often precede changes noted on radiographs.[31]

Bone scan abnormalities, found in 15% of patients, less commonly involve the mandible, the maxilla, the clavicles, the scapulae, and the patellae.

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Contributor Information and Disclosures
Author

Supriya Goyal, MD  Consulting Dermatologist

Supriya Goyal, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Gregory M Richards, MD  Clinical Assistant Professor, Department of Human Oncology, University of Wisconsin School of Medicine and Public Health

Gregory M Richards, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, American Medical Association, American Roentgen Ray Society, American Society of Clinical Oncology, American Society of Therapeutic Radiation Oncology, and Radiological Society of North America

Disclosure: Nothing to disclose.

Rajiv Goyal, MD  Radiologist, Department of Radiology, Kaiser Permanente Medical Center

Rajiv Goyal, MD is a member of the following medical societies: American Medical Association, American Roentgen Ray Society, MedChi, and Radiological Society of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Pelle, MD  Clinical Assistant Professor, Division of Dermatology, Department of Medicine, University of California, San Diego, School of Medicine

Michelle Pelle, MD is a member of the following medical societies: American Academy of Dermatology, California Medical Association, Medical Dermatology Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Van Perry, MD  Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

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