Diferencia entre revisiones de «Clubbing»
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[[File:Dedos con acropaquia.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.]] | [[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== | ||
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**Interstitial fibrosis | **Interstitial fibrosis | ||
**Bronchiectasis | **Bronchiectasis | ||
**Lung | **[[Lung cancer]] | ||
**Empyema | **[[Empyema]] | ||
**Cystic | **[[Cystic fibrosis]] | ||
*Other Systemic Conditions | *Other Systemic Conditions | ||
** | **Cyanotic [[congenital heart disease]] | ||
**Endocarditis | **[[Endocarditis]] | ||
**Liver | **[[Liver cirrhosis]] | ||
**Chronic | **Chronic [[diarrhea]] | ||
*Hereditary | *Hereditary | ||
*Idiopathic | *Idiopathic | ||
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<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. | 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]] | |||
Revisión actual - 18:28 29 ene 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.