Pachydermoperiostosis Workup

Updated: May 11, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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Workup

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. [38] 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. [39, 40]

Other radiographic abnormalities include the following [41] :

  • 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. [42, 41] 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. [43]

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

Ultrasound may document echogenic tissue surrounding the long bones; Doppler sonograms may show increased vascularity on the surface of some superficial bony structures. [38]

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