Kerith E. Spicknall, BA, Matthew J. Zirwas, MD, Joseph C. English, MD

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Presentation transcript:

Clubbing: An update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance Kerith E. Spicknall, BA, Matthew J. Zirwas, MD, Joseph C. English, MD Journal of the American Academy of Dermatology Volume 52, Issue 6, Pages 1020-1028 (June 2005) DOI: 10.1016/j.jaad.2005.01.006 Copyright © 2005 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Profile sign/Lovibond sign (red line); modified profile sign (yellow line); hyponychial angle (green line); and distal phalangeal to interphalangeal depth ratio (black line). Normal (A) and clubbed (B) fingers. Journal of the American Academy of Dermatology 2005 52, 1020-1028DOI: (10.1016/j.jaad.2005.01.006) Copyright © 2005 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Profile sign/Lovibond sign (red line); modified profile sign (yellow line); hyponychial angle (green line); and distal phalangeal to interphalangeal depth ratio (black line). Normal (A) and clubbed (B) fingers. Journal of the American Academy of Dermatology 2005 52, 1020-1028DOI: (10.1016/j.jaad.2005.01.006) Copyright © 2005 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Normal (A) and obliterated (B) Schamroth's sign in clubbing. Journal of the American Academy of Dermatology 2005 52, 1020-1028DOI: (10.1016/j.jaad.2005.01.006) Copyright © 2005 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Normal (A) and obliterated (B) Schamroth's sign in clubbing. Journal of the American Academy of Dermatology 2005 52, 1020-1028DOI: (10.1016/j.jaad.2005.01.006) Copyright © 2005 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Algorithm for evaluation of unilateral clubbing. AV, Arteriovenous; H&P, history and physical examination; N, no; Y, yes. Journal of the American Academy of Dermatology 2005 52, 1020-1028DOI: (10.1016/j.jaad.2005.01.006) Copyright © 2005 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 Algorithm for evaluation of bilateral clubbing. ALT, Alanine aminotransferase; AST, aspartate aminotransferase; CBC, complete blood cell count; CT, computed tomography; CXR, chest radiograph; GI, gastrointestinal; HOA, hypertrophic osteoarthropathy; IBD, inflammatory bowel disease; ID, infectious disease; POEMS, polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes; PPD, purified protein derivative; RUQ, right upper quadrant; TSH, thyroid-stimulating hormone. Journal of the American Academy of Dermatology 2005 52, 1020-1028DOI: (10.1016/j.jaad.2005.01.006) Copyright © 2005 American Academy of Dermatology, Inc. Terms and Conditions