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