Hypertrophic osteoarthropathy in a child due to thoracic Hodgkin’s disease

Abstract

Keywords Hodgkins disease.Osteoartropathy.Radiographs.CTThere is periosteal reaction along the shaft of the longbones of the hand and foot, leading to the diagnosis ofhypertrophic osteoarthropathy (HPOA), associated withintrathoracic Hodgkin’s disease.DiscussionHypertrophic osteoarthropathy in children is rare and istypically considered to be a sign of pulmonary disease [1–3]. However, it may be related to a variety of inflammatoryor neoplastic disorders, including congenital heart diseases,pulmonary or cystic fibrosis, infectious airway disease,chronic liver and inflammatory bowel disease as well asvarious intrathoracic and gastrointestinal tumours [1–3].While up to 90% of HPOA cases are associated withprimary or metastatic pulmonary neoplasms in adults,intrathoracic malignant disease accounts for only 12% ofHPOA cases in children [1–3]. The presence of HPOA hasbeen regarded as a poor prognostic sign, since most of thepatients with malignancy and HPOA have showed exten-sive metastases [2]. Therefore, although HPOA is rare inchildhood cancers, its occurrence should alert physiciansfor the recurrence of disease or intrathoracic involvementduring follow-up [2–4].HPOA has a characteristic radiological appearance [1–4]. Initially, there is periosteal new bone formation forminga thin radiopaque line around the cortex and separated fromit by a radiolucent band. In our patient, this pattern isevident at both the X-rays, and the CT. Subsequently, thetwo layers gradually fuse and lead to poorly demarcated orlamellar periosteal reaction. This appearance may be easilydifferentiated from bone involvement from the Hodgkin’sdisease itself, as periosteal infiltration by lymphoma usuallyaffects the anterior surfaces of the vertebral bodies ratherthan the long bones and is always associated with corticalbone destruction [1–4].In pediatric Hodgkin’s lymphoma,