Clubbing and Hypertrophic Osteoarthropathy

Marie,1in 1890, and Bamberger,2in 1891, first described the syndrome that bears their name, more widely known as hypertrophic pulmonary osteoarthropathy. Since that time, medical literature has recorded divergent opinions regarding the incidence of this disorder in certain diseases and the relationship of simple digital clubbing to hypertrophic osteoarthropathy. It is accepted that a variety of common pulmonary lesions, most notably bronchogenic carcinoma, empyema, bronchiectasis, and pulmonary abscess, as well as rarer conditions, such as carcinoma of the thymus3and pleural mesothelioma,4may be associated with the disorder. The recognition of hypertrophic osteoarthropathy becomes of great import when it is realized that it may be the earliest sign of bronchogenic carcinoma. It has been emphasized that osteoarthropathy may precede, by as much as 18 months,5the pulmonary symptoms of neoplasm of the lung, in contrast to the slowly developing chronic variety associated with suppurative