Clubbing

Clubbing of the digits is a cardinal sign of pulmonary disease. It is the finding of increased vascular connective tissue in the distal segments of the digits, which results in the characteristic enlargement of the tips of the digits and exaggerated curvature. Clubbing may occur in isolation, or it may be part of a syndrome called hypertrophic osteoarthropathy, in which periostosis (deposition of new bone) of long bones and joint pains also occur.

 

Patient 1:

This is a middle-aged woman with cirrhosis who was found to have digital clubbing, likely caused by hepatopulmonary syndrome. Also note the palmar erythema.

Patient 2:

This is a middle-aged man with cystic fibrosis with cyanosis and digital clubbing.

Patient 3:

This is a middle-aged woman with cirrhosis who was found to have digital clubbing, likely caused by hepatopulmonary syndrome.

Patient 4:

This is a middle-aged man with cirrhosis complicated by hepatopulmonary syndrome with digital clubbing.

Image courtesy of “Frameworks for Internal Medicine

Patient 5:

This is an older man with idiopathic pulmonary fibrosis.

Patient 6:

This patient has