Clubbing DDx

Overview

Clubbing is an abnormality of the fingertips with following features:

  • beaked nails
  • loss of angle between nail bed and finger
  • increased AP width of finger tip
  • sponginess of proximal nail bed

Causes

Cardiovascular

Common

  • Cyanotic congenital heart disease
  • Infective endocarditis

Respiratory

common

  • lung cancer (not small cell cancer)
  • chronic pulmonary suppuration
  • bronchiectasis
  • lung abscess
  • empyema
  • Idiopathic pulmonary fibrosis
  • cystic fibrosis
  • asbestosis
  • pleural mesothelioma or fibroma

uncommon

  • Cystic fibrosis
  • Asbestosis
  • Pleural mesothelioma (benign fibrous type) or pleural fibroma

Other uncommon causes

Gastrointestinal

  • Cirrhosis (especially biliary cirrhosis)
  • Inflammatory bowel disease
  • Coeliac disease

Other

  • Thyrotoxicosis
  • Familial (usually before puberty) or idiopathic

Rare causes

  • Neurogenic diaphragmatic tumours
  • Pregnancy
  • Secondary hyperparathyroidism

Unilateral clubbing

  • Bronchial arteriovenous aneurysm
  • Axillary artery aneurysm

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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