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Journal of the American Academy of Dermatology
Volume 52, n° 6
pages 1020-1028 (juin 2005)
Doi : 10.1016/j.jaad.2005.01.006
CLINICAL REVIEWS

Clubbing: An update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance
 

Kerith E. Spicknall, BA, Matthew J. Zirwas, MD, Joseph C. English, MD
From the Department of Dermatology, University of Pittsburgh 

Reprint requests: Joseph C. English III, MD, 190 Lothrop St, Suite 145, Pittsburgh, PA 15213.

Pittsburgh, Pennsylvania

Abstract

Finger clubbing can be a striking physical finding. At other times, the presence of clubbing is difficult to establish by subjective examination alone and the profile angle or distal phalangeal to interphalangeal depth ratio are needed to confirm the finding. Most microscopic and imaging studies of clubbed fingers reveal hypervascularization of the distal digits. Recent research shows that when platelet precursors fail to become fragmented into platelets within the pulmonary circulation, they are easily trapped in the peripheral vasculature, releasing platelet-derived growth factor and vascular endothelial growth factor, promoters of vascularity and, ultimately, clubbing. Clinically, clubbing is associated with a number of neoplastic, pulmonary, cardiac, gastrointestinal, infectious, endocrine, psychiatric, and multisystem diseases. In narrowing the differential diagnosis, we recommend a detailed history and physical examination accompanied by focused laboratory and imaging studies. An algorithm for the evaluation of newly diagnosed clubbing is suggested.

The full text of this article is available in PDF format.

 Funding sources: None.
Conflicts of interest: None identified.



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