A patient with nasopharyngeal carcinoma developed clubbing and hypertrophic osteoarthropathy 6 months before radiological detection of secondary deposits in the lung. Another patient with nasopharyngeal carcinoma developed digital clubbing and hypertrophic osteoarthropathy 6 months after the discovery of lung metastases. Development of a paraneoplastic syndrome in the form of hypertrophic osteoarthropathy and digital clubbing is very rare. This manifestation of nasopharyngeal cancers is presented, with a short review of its biology and pathogenesis.
Some diseases may underlie finger clubbing. However, there is a dearth of information about early stage of finger clubbing because only few researchers have shown interest in it. We determined the Digital Index of normal, healthy subjects by using thread and manual Vernier calipers, the time used for the procedure, and its interrater reliability. The value of Digital Index was 8.86 ± 0.29 (Mean ± SD) with a range of 8.15 to 9.41. Interrater reliability was excellent with Pearson's correlation coefficient of 0.966. Overall, the time taken to measure the Digital Index ranged from 21.93 to 68.80 minutes with an average of 35.97 ± 9.16 (Mean ± SD). Determining Digital Index need much time, but this can be overcome if we use Digital Index Quantitator (DIQ). Availability of DIQ in the hospital wards will be of much benefit. DIQ can also be used to accurately quantify the progression or regression of the clubbing process. This article proves that we need morphometry of digital clubbing as well as the correlation of the physical sign of clubbing with Digital Index.
Pulmonary arteriovenous malformations are rare vascular anomalies. We report a 12-year-old girl who presented with exertional dyspnoea, cyanosis and clubbing since the age of five years, and multiple pulmonary arteriovenous malformations. Computed tomography pulmonary angiogram showed a large pulmonary arteriovenous malformation at the lower lobe of the right lung. Pulmonary angiogram showed a large right lung arteriovenous malformation and two small left lung arteriovenous malformations. The multiple arteriovenous malformations were occluded with Gianturco coils. She is now asymptomatic and on regular follow-up.