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

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