Hypertrophic Osteoarthropathy

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Radiography: 1.50
Procedures: 1.50
Thorax and Abdomen Procedures: 0.50
Extremity Procedures: 1.00

Outline

1. Introduction
2. Classification and Nomenclature of HOA
3. Pathogenesis and Etiology of HOA
   1. Primary HOA
   2. Secondary HOA
4. Clinical Presentation of HOA
   1. Primary HOA
   2. Secondary HOA
5. Imaging Features of HOA
   1. Radiography and CT
   2. MR Imaging
   3. Bone Scintigraphy
   4. Positron Emission Tomography
6. Differential Diagnosis of HOA
   1. Thyroid Acropachy
   2. Variconazole-induced Periostitis
   3. Venous Stasis or Insufficiency
   4. Leukemia and Lymphoma
   5. Hypervitaminosis A
   6. Progressive Diaphyseal Dysplasia
7. Prognosis and Treatment of HOA
   1. Primary HOA
   2. Secondary HOA
8. Conclusion

Objectives

Upon completion of this course, students will:

1. list the clinical features of hypertrophic osteoarthropathy
2. state one of the oldest clinical signs of hypertrophic osteoarthropathy
3. list the synonyms for clubbing
4. indicate when hypertrophic osteoarthropathy was distinguished from acromegaly
5. identify the male to female ratio of hypertrophic osteoarthropathy
6. list other names for primary hypertrophic osteoarthropathy
7. compare the occurrence of secondary hypertrophic osteoarthropathy to primary hypertrophic osteoarthropathy
8. state the number of models currently in existence that help explain the pathogenesis associated with hypertrophic osteoarthropathy
9. correlate the relationship of lung functions to secondary hypertrophic osteoarthropathy
10. explain the histologic contributors to secondary hypertrophic osteoarthropathy
11. state the most common cause of hypertrophic osteoarthropathy
12. recall the incidence of hypertrophic osteoarthropathy in lung cancer patients
13. name the clinical symptom seen in the majority of hypertrophic osteoarthropathy cases
14. identify the methods to diagnose clubbing
15. state the digital index necessary to determine clubbing
16. list the subtypes of pachydermoperiostosis associated with primary hypertrophic osteoarthropathy
17. recall the most common subtype of primary hypertrophic osteoarthropathy
18. select the most advanced stage of skin hypertrophy
19. choose the imaging modality used first to evaluate pain associated with hypertrophic osteoarthropathy
20. list soft-tissue radiographic findings associated with hypertrophic osteoarthropathy
21. state where periostosis normally manifests
22. select the bones most commonly affected by periostosis
23. list the multiple periosteal reactions in bone
24. state the signal intensity associated with periosteal reaction as seen on MR T2-weighted images
25. choose the findings at MR imaging of extremities that can be indistinguishable
26. identify the imaging modality in which a tram line or double stripe sign can be seen
27. state the role bone scintigraphy plays in hypertrophic osteoarthropathy
28. explain how thyroid acropachy usually arises
29. list the metacarpals affected by thyroid acropachy
30. state symptoms experienced by patients with Voriconazole-induced periostitis
31. list the appearance of periosteal reaction in patients with Voriconazole-induced periostitis
32. know the imaging modality that can definitively show any associated marrow and soft-tissue abnormality involved by tumor
33. state the origin of Hypervitaminosis A
34. select the type of bones affected by Hypervitaminosis A
35. describe progressive diaphyseal dysplasia
36. list the comorbidities associated with primary hypertrophic osteoarthropathy
37. recall how primary hypertrophic osteoarthropathy is usually treated
38. state the prevalence of malignancy in patients with secondary hypertrophic osteoarthropathy
39. list the surgical options for treating the underlying cause of secondary hypertrophic osteoarthropathy
40. state causes of multi-focal periostitis