ARRS Case of the Week

NUCLEAR MEDICINE: Musculoskeletal

Case Author: Gary A. Ulaner, MD, PhD, Memorial Sloan-Kettering Cancer Center


58-year-old woman with bilateral leg pain and stiffness.

Imaging Findings

Posterior (left) and anterior (right) planar bone scans show bilateral diffuse periosteal uptake in the lower extremities.

  • Hypertrophic osteoarthropathy
  • Insufficiency fractures
  • Shin splints
  • Synovitis


Hypertrophic osteoarthropathy

Teaching Points

Hypertrophic osteoarthropathy (HOA) is a syndrome of long bone periostitis, digit clubbing, and bone and joint pain. HOA can be primary (without underlying cause) or secondary. Secondary HOA can be caused by pulmonary, pleural, cardiac, or abdominal disease, including lung cancer, tuberculosis, fibrous tumor of the pleura, ulcerative colitis, Crohn disease, and gastrointestinal neoplasms. In patients with symptoms of shin splints and normal radiographic findings, both bone scan and MRI may depict abnormalities occult on radiographs. Bone scintigraphy and MRI are more sensitive than radiography for detection of pelvic insufficiency fractures.

Suggested Readings

Davies RA, Darby M, Richards MA. Hypertrophic pulmonary osteoarthropathy in pulmonary metastatic disease: a case report and review of the literature. Clin Radiol 1991; 43:268–271
Martinez-Lavin M, Vargas A, Rivera-Viñas M. Hypertrophic osteoarthropathy: a palindrome with a pathogenic connotation. Curr Opin Rheumatol 2008; 20:88–91

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