Hypertrophic Pulmonary Osteoarthropathy
Bilateral metadiaphyseal lamellated periosteal reaction.
Periostitis is the hallmark of HPOA and occurs usually in
the metadiaphyseal regions of the ulnae, radii, fibulae
and tibiae. Less commonly, the femora, humerii,
metacarpals and metatarsals may be involved. The typical
feature is that periostitis does not extend to the epiphysis.
Usually smooth multi layered laminated new bone
formation is seen. Rarely simple elevation of the
periosteum or periosteal cloaking may be seen.(Source [1]Resnick Diagnosis of Joint and Bone Disorders
This was patients initial presentation , on further enquiry the patient had had ? low grade lower respiratory tract infection - subsequent CXR then CT , biopsy revealed small cell cancer with multiple pulmonary emboli noted on CT
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