digital clubbing in pediatric age group by dr. deboprasad das
Post on 01-Apr-2015
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DIGITAL CLUBBING IN PEDIATRIC AGE
GROUP
By Dr. Deboprasad Das
CRITERION FOR CLUBBING
A finger can be called as clubbed finger when:
1. lovibond angle > 180 degrees
2. Schamroth sign is positive
3. phalangeal depth ratio > 1
LOVIBOND ANGLE
The angle between the nail bed and the nail is
known as Lovibond angle. Normally its an acute
angle
In clubbing the lovibond angle is >180degrees
LOVIBOND ANGLE
SCHAMROTH SIGN
When the distal phalanges (bones nearest the
fingertips) of corresponding fingers of opposite
hands are directly opposed (place fingernails of same
finger on opposite hands against each other, nail to
nail), a small diamond-shaped "window" is normally
apparent between the nailbeds. If this window is
obliterated, the test is positive and clubbing is
present.
Dr. Schamroth demonstrated it first in his own
finger
SCHAMROTH’S SIGN
PHALANGEAL DEPTH RATIO
In a normal finger the Inter phalangeal Depth (IPD)
is more than the Distal phalangeal Depth(DPD)
In clubbing DPD/IPD>1
DPD:IPD>1
TYPES OF CLUBBING
Unilateral or bilateral
Primary or secondary
Acute or chronic
ACUTE CLUBBING
Acute clubbing develops within 2-3 weeks.
Mostly seen in: Suppurative lung disorders(in lung
abscess clubbing can be seen in 10-14days)
Mesothelioma
Bacterial endocarditis
CHRONIC CLUBBING
Chronic clubbing develops in about 6 months as in
cyanotic heart diseases such as Tetralogy of Fallot.
In bronchiectasis clubbing may take upto 1year to
develop
PRIMARY FORM OF CLUBBING
Primary form of clubbing is generally idiopathic or
hereditary.
Pachydermopriostosis contributes to about 85% of
primary form of clubbing.
SECONDARY FORM OF CLUBBING
Secondary form of clubbing is mostly secondary to
systemic illness affecting mainly respiratory system,
cardiovascular system, hepatobiliary system and
gastrointestinal system, and hence is bilateral in
general.
Suppurative:
Bronchiectasis
Lung abscess
Empyema
Pulmonary TB
RESPIRATORY SYSTEM DISEASES ASSOCIATED WITH
CLUBBING
Neoplastic:
Bronchial adenoma
Mesothelioma
Bronchogenic
carcinoma(common in
adults)
Cyanotic congenital
heart diseases:
Tetralogy of Fallot
Transposition
of Great Cardiac vessels
Ventricular
Septal Defects
Ebstein
anomaly
CARDIOVASCULAR DISEASES
Bacterial endocarditis
Atrial myxomas
Chronic congestive
heart failure
GASTROINTESTINAL DISEASES
Cirrhosis
Malabsorption syndrome
Intestinal polyposis
Inflammatory bowel disease(ulcerative colitis and
Crohn’s disease)
ENDOCRINE DISEASES
Myxoedema
Thyrotoxicosis
DIFFERENTIAL CLUBBING
It refers to clubbing with cyanosis limited to either
upper or lower limbs.
Clubbing with cyanosis limited to lower limb is
seen in Patent Ductus Arteriosus with a reversed
shunt
Clubbing with cyanosis limited to upper limb is
seen in Transposition of great vessels with PDA with
reverse shunt.
PSEUDOCLUBBING
As the name suggests, it refers to appearance of
clubbing without actual presence of it, seen in:
Hyperparathyroidism: there is excessive resorption
of distal phalanges
Hansen’s disease
Leukemia: bone destruction due to secondary
deposits
Thank you
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