Question 24.1

College Answer

°     Inflammatory bowel disease

°     Thyrotoxicosis

°     Idiopathic

°     Familial

°     Cirrhosis

°     Celiac

°     Pregnancy

Discussion

There are numerous causes of clubbing.

Here is an unreasonably long list:

Causes of bilateral clubbing in both hands and feet

Cardiac

• Congenital heart disease, particularly cyanotic defects
• Congestive cardiac failure
• Aortic aneurysm
• Subacute bacterial endocarditis
• Arteriovenous fistula (and it would have to be a major one)

Respiratory

• Chronic lung disease of any sort, really;
  • Bronchiectasis, which makes you think of cystic fibrosis
  • COPD, asbestosis
  • Pulmonary fibrosis of any aetiology
  • Empyema which has been going on for a while
• Lung carcinoma (according T and O’C, usually not the small-cell variety)

Gastrointestinal

• Cirrhosis; for some reason, particularly primary biliary cirrhosis
• Coeliac disease
• Inflammatory bowel disease
• Malignancy of the colon

Uncommon causes of clubbing

• Thyrotoxicosis
• Pregnancy
• Syringomyelia
• Hyperparathyroidism
• Pregnancy
• Inherited familial (some people are just born that lucky – it’s a Mendelian dominant trait)

Causes of clubbing in feet only

• Coarctation of aorta
• Abdominal aortic aneurysm

Causes of unilateral clubbing 

• Any sort of arterial aneurysm leading into the clubbed limb
• Apical lung tumour
• Hemiplegia

Clinical Examination of the Critically Ill Patient, 3rd edition by L.I.G. Worthley - which can be ordered from our college here.

Clinical Examination: whatever edition, by Talley and O'Connor. Can be acquired any damn where. Get your own.

Rutherford, John D. "Digital Clubbing." Circulation 127.19 (2013): 1997-1999.

Velur, Prasuna, and Giridhar P. Kalamangalam. "Teaching NeuroImages: Unilateral clubbing in hemiplegia." Neurology 78.19 (2012): e122-e122.

Stoller, James K., et al. "Reduction of intrapulmonary shunt and resolution of digital clubbing associated with primary biliary cirrhosis after liver transplantation." Hepatology 11.1 (1990): 54-58.

Dickinson, C. J., and J. F. Martin. "Megakaryocytes and platelet clumps as the cause of finger clubbing." The Lancet 330.8573 (1987): 1434-1435.