Characteristics

• Rare condition occurring secondary to various pathological states such as bronchogenic carcinoma, chronic chest infections, inflammatory bowel and liver disease.

• Thought to occur due to release of vasoactive mediators not metabolised by lung.

Clinical features

• Patients present with a burning pain associated with soft-tissue swelling and joint stiffness.

• Ankles, wrists, knees and elbows are commonly affected.

• Clubbing of fingers and toes may be evident. Limb hypertrophy may occur secondary to soft-tissue swelling.

• Peripheral neurovascular effects include cyanosis, blanching, flushing, paraesthesia and hyperhydrosis.

Radiological features

• Periosteal new bone formation at the diametaphysis. Commonest in the tibia and fibula. Other common sites include radius and ulna, proximal phalanges, femur and pelvis.

• Soft tissue swelling around the distal phalanges.

• A bone scan demonstrates symmetrical periosteal uptake.

• Cross-sectional imaging is performed to identify the underlying cause.

Management

• Directed at treatment of the underlying cause.

• Regression of the periosteal reaction may be seen after treatment.