Dr. Santu Das (Dermatology) needs a second opinion on this medical case.
This photo was taken by a paramedic that met a 56 year old lady who was diagnosed with Idiopathic Pulmonary Fibrosis and is currently waiting for a lung transplant. She couldn’t help but notice the amazing clubbing she had!
Clubbing is associated with lung cancer, lung infections, interstitial lung disease, cystic fibrosis, or cardiovascular disease. It may also run on families.
The term is used to describe an enlargement of the distal phalanges of the fingers, giving them a drumstick or club-like appearance.
Alterations in size and configuration of the clubbed digit result from changes in the nail bed, beginning with increased interstitial edema early in the process. As clubbing progresses, the volume of the terminal portion of the digit may increase because of an increase in the vascular connective tissue and change in quality of the vascular connective tissue, although some cases have been associated with spurs of bone on the terminal phalanx.
Although clubbing is a common physical finding in many underlying pathological processes, surprisingly, the mechanism of clubbing remains unclear. Different pathological processes may follow different pathways to a common end.
Many researchers agree that the common factor in most types of clubbing is distal digital vasodilation, which results in increased blood flow to the distal portion of the digits. Whether the vasodilation results from a circulating or local vasodilator, neural mechanism, response to hypoxemia, genetic predisposition, or a combination of these or other mediators is not agreed on currently.
Hypoxia (reduced amount of oxygen in the blood), due to a chronic pulmonary disease, is an alternative explanation for clubbing in cyanotic heart disease and pulmonary diseases. An increase in hypoxia may activate local vasodilators, consequently increasing blood flow to the distal portion of the digits; however, in most cases, hypoxia is absent in the presence of clubbing, and many diseases with noted hypoxia are not associated with clubbing.