Presentation
Ulcerative colitis, not well-treated with mesalazine and steroids. Onset of pain in the forearms and lower limbs, particularly in the wrists and ankles.
Patient Data
Forearms and lower limbs
Diffuse cortical thickening of the diaphysis of the femurs of the tibiae and fibulas as well as of the radius and ulna diaphysis with enlargement of the bones and periosteal new bone formation, always on both sides. Bilateral gonarthrosis and coxarthrosis.
Abdominal ultrasound
Wall thickening of the entire colon with loss of multilayer pattern and marked Doppler signal associated with “comb sign” with parallel mesenteric vessels as a sign of severe inflammation (Limberg Score 4). It is accompanied by creeping fat and ulcers.
Histologically report of colonoscopic biopsies
The mucosal surface is irregular, with edema, interstitial hemorrhage, and inflammatory exudate in the lamina propria. In the mucosa, there is also interstitial infiltration of lymphocytes, plasma cells, eosinophils, and neutrophils, with erosions and exudate of neutrophils from crypt abscesses. Findings correlated with active ulcerative colitis with transmucosal distribution, with an abnormally high density of neutrophils, lymphocytes, and plasma cells in the lamina propria with mucosal erosions and ulceration.
Note the soft-tissue clubbing of the terminal phalanges of the hands with speculated periostosis of the distal radius and ulna on both sides.
Detail of the speculated periostosis on the lower parts of the tibia and fibula on both sides. The same finding occurs at the level of the radius and ulna, distally. There's also smooth cortical thickening in the diaphysis of the tibia and fibula of both legs, especially the tibiae.
Case Discussion
Non-small cell lung cancer (NSCLC) is the most common cause of clubbing and hypertrophic osteoarthropathy.
Other conditions associated with clubbing are cardiovascular diseases such as congenital cyanotic heart disease and infective endocarditis or gastrointestinal diseases such as cirrhosis, primary sclerosing cholangitis, Crohn's disease and ulcerative colitis.
Finger clubbing is usually bilateral and symmetrical. Rare cases of unidigital clubbing are described in sarcoidosis.
Imaging technologists : TSRM Nunzio Bianco, TSRM Simone Pasini
Unable to process the form. Check for errors and try again.