Abstract
The patient, a 45-year-old male, was referred to the rheumatology clinic due to diffuse joint pain on the wrists and knees. The patient was diagnosed with liver cirrhosis and severe hepatopulmonary syndrome. Physical examination showed swelling of the knees and wrists (arthritis) and clubbing. The X-rays requested showed periosteal thickening observed continuously, in a diaphysometaphysiary location of the radius and ulna in both forearms, and predominantly in distal femurs and both knees, compatible with nonaggressive periosteal reaction. Fig. 1 shows periosteal thickening affecting both femurs on the concave bone edge and respecting the epiphysis, and equal involvement of the radius and ulna on the right wrist, in Fig. 2.
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