Causes of Clubbing

Posted on November 2, 2011

11


Flushed with the success of my performance on Monday morning’s ward round, I’ve decided to write a post on the causes of clubbing of the fingers. Don’t know if anyone will ever read it, but at least writing it out like this will help me to remember if nothing else.

Before we get started, here’s a picture of some good finger clubbing (taken from surgicalnotes.co.uk):

Clubbing occurs in 5 steps (thanks wikipedia: http://en.wikipedia.org/wiki/Nail_clubbing)

1. Fluctuation/softening of the nail bed

2. Loss of the angle between nail bed and nail fold

3. Increased convexity of the nail fold

4. Thickening of the distal finger

5. Shiny aspect/striation of the skin and nail

CAUSES OF CLUBBING

While clubbing can be idiopathic, here are the causes of clubbing by organ system:

THORACIC

Bronchial lung Ca (though usually NOT small cell LCa)

Chronic lung suppuration (Empyema, abscess, bronchiectasis, cystic fibrosis)

Fibrosing alveolitis

Mesothelioma

TB

CARDIOVASCULAR

Cyanotic congenital heart disease

Endocarditis

Atrial myxoma

GASTROINTESTINAL

Irritable bowel disease (especially Crohn’s)

Cirrhosis

GI Lymphoma

Malabsorption (eg Coeliac)

RARE

Thyroid acropachy

Oesophageal Ca

And if you’re worrying that you’ll never commit all that to memory, there’s a handy mnemonic to go with it. Just remember CLUBBING (with ABCDEF for lung diseases):

C yanotic heart disease

L ung diseases

A bscess

B ronchiectasis

C ystic fibrosis

D on’t say COPD!!!!

E mpyema

F ibrosis

U lceratice colitis + Crohn’s (Inflammatory bowel diseases)

B iliary cirrhosis

B irth defect

I nfective endocarditis

N eoplasm (Lung Ca, mesothelioma)

G I malabsorption (Coeliac disease)

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