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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Digital clubbing refers to focal enlargement of connective tissue at the distal phalanges of fingers or toes&#46; It is particularly prominent on dorsal surfaces and is often bilateral&#46; Clinically&#44; it is characterized by an increased Lovibond angle&#44; which is the angle made by the proximal nail fold and the nail plate and normally measures 160&#176; or less &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41;&#46; In clubbing&#44; it is larger than 180&#176;&#44; forming what is known as the Schamroth sign&#46; The most common causes of digital clubbing are pulmonary &#40;75&#37;&#8211;80&#37; of cases&#41;&#44; cardiac &#40;10&#37;&#8211;15&#37;&#41;&#44; gastrointestinal &#40;5&#37;&#8211;10&#37;&#41;&#44; and thyroid &#40;among others&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Ultrasound is a useful tool for evaluating the anatomy and structures of the nail unit as these show different degrees of echogenicity&#46; In addition&#44; Doppler measurements are helpful for assessing the vascularization of the nail matrix and nail bed&#46; Ultrasound imaging has been used to characterize abnormalities observed in nail psoriasis and tumors of the nail and surrounding tissues&#44; as well as nail changes in patients with autoimmune&#44; infectious&#44; and inflammatory diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In this report&#44; we describe ultrasound findings observed in a patient with digital clubbing&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 46-year-old male smoker presented with hand eczema of 2 weeks&#8217; duration and paronychia secondary to onychophagia&#46; The physical examination revealed clubbing &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>b&#41;&#44; which the patient said had been present since childhood&#59; he denied a family history of nail abnormalities and reported no pain or mechanical symptoms&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We studied the nail unit using high-frequency ultrasound with a 10&#8211;22<span class="elsevierStyleHsp" style=""></span>MHz linear probe connected to an Esaote MyLab Class C system&#46; The longitudinal view revealed an enlarged nail bed&#44; with a diameter of 3<span class="elsevierStyleHsp" style=""></span>mm &#40;normal measurements are &#8804;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm &#91;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#93;&#41;&#44; and increased vascularization through the full thickness of the bed&#46; No alterations were observed in the bone surface of the distal phalanx &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The most widely accepted pathophysiologic hypothesis to explain clubbing is proliferation of vascular connective tissue due to platelets and platelet-derived growth factors &#40;PDGFs&#41;&#46; In the case of pulmonary diseases&#44; it is assumed that circulating megakaryocytes cross from venous blood to arterial blood and are delivered to the extremities&#44; where they release growth factors such as PDGFs&#46; Normally&#44; megakaryocytes do not fragment until they are trapped in the pulmonary capillaries&#44; which is why clubbing is mainly associated with pulmonary diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Clubbing must be distinguished from pachyperiostitis&#44; which is clinically characterized by subperiosteal bone neoformation associated with pain &#40;hypertrophic osteoarthropathy&#41;&#44; polyarthritis&#44; cutis verticis gyrata&#44; pachydermia&#44; seborrhea&#44; and hyperhidrosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">8&#44;9</span></a> None of these features were observed in our patient&#46; Ultrasound findings in pachyperiostitis include echogenic tissue surrounding the long bones&#44; reflecting the presence of edema and inflammation&#46; Doppler imaging shows increased vascularization on the surface of some superficial bony structures&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Cutaneous ultrasound is an inexpensive&#44; rapidly accessible&#44; noninvasive tool for exploring the anatomy of the nail unit&#46; In addition&#44; it is useful for distinguishing between clubbing and pachyperiostitis without the need for ionizing radiation&#46; Underlying disease must always be ruled out in such cases&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This is the first case in the literature to describe ultrasound findings in a patient with digital clubbing&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letter
Digital Clubbing: Ultrasound Findings
Ecografía de acropaquia digital
C. Fernandez-Quirogaa,
Autor para correspondencia
drafernandezquiroga@gmail.com

Corresponding author.
, F. Alfageme-Roldánb, G. Roustan-Gullónb
a Unidad de Dermatología, Hospital General de Agudos Carlos G. Durand, Ciudad Autónoma de Buenos Aires, Argentina
b Servicio de Dermatología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
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    "titulo" => " Digital Clubbing&#58; Ultrasound Findings"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; High-frequency ultrasound showing a normal nail in the longitudinal plane&#46; &#40;b&#41; Similar image of the distal phalanx&#46; Note the thickened nail bed and increased vascularization&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Digital clubbing refers to focal enlargement of connective tissue at the distal phalanges of fingers or toes&#46; It is particularly prominent on dorsal surfaces and is often bilateral&#46; Clinically&#44; it is characterized by an increased Lovibond angle&#44; which is the angle made by the proximal nail fold and the nail plate and normally measures 160&#176; or less &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41;&#46; In clubbing&#44; it is larger than 180&#176;&#44; forming what is known as the Schamroth sign&#46; The most common causes of digital clubbing are pulmonary &#40;75&#37;&#8211;80&#37; of cases&#41;&#44; cardiac &#40;10&#37;&#8211;15&#37;&#41;&#44; gastrointestinal &#40;5&#37;&#8211;10&#37;&#41;&#44; and thyroid &#40;among others&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Ultrasound is a useful tool for evaluating the anatomy and structures of the nail unit as these show different degrees of echogenicity&#46; In addition&#44; Doppler measurements are helpful for assessing the vascularization of the nail matrix and nail bed&#46; Ultrasound imaging has been used to characterize abnormalities observed in nail psoriasis and tumors of the nail and surrounding tissues&#44; as well as nail changes in patients with autoimmune&#44; infectious&#44; and inflammatory diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In this report&#44; we describe ultrasound findings observed in a patient with digital clubbing&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 46-year-old male smoker presented with hand eczema of 2 weeks&#8217; duration and paronychia secondary to onychophagia&#46; The physical examination revealed clubbing &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>b&#41;&#44; which the patient said had been present since childhood&#59; he denied a family history of nail abnormalities and reported no pain or mechanical symptoms&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We studied the nail unit using high-frequency ultrasound with a 10&#8211;22<span class="elsevierStyleHsp" style=""></span>MHz linear probe connected to an Esaote MyLab Class C system&#46; The longitudinal view revealed an enlarged nail bed&#44; with a diameter of 3<span class="elsevierStyleHsp" style=""></span>mm &#40;normal measurements are &#8804;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm &#91;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a&#93;&#41;&#44; and increased vascularization through the full thickness of the bed&#46; No alterations were observed in the bone surface of the distal phalanx &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>b&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The most widely accepted pathophysiologic hypothesis to explain clubbing is proliferation of vascular connective tissue due to platelets and platelet-derived growth factors &#40;PDGFs&#41;&#46; In the case of pulmonary diseases&#44; it is assumed that circulating megakaryocytes cross from venous blood to arterial blood and are delivered to the extremities&#44; where they release growth factors such as PDGFs&#46; Normally&#44; megakaryocytes do not fragment until they are trapped in the pulmonary capillaries&#44; which is why clubbing is mainly associated with pulmonary diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Clubbing must be distinguished from pachyperiostitis&#44; which is clinically characterized by subperiosteal bone neoformation associated with pain &#40;hypertrophic osteoarthropathy&#41;&#44; polyarthritis&#44; cutis verticis gyrata&#44; pachydermia&#44; seborrhea&#44; and hyperhidrosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">8&#44;9</span></a> None of these features were observed in our patient&#46; Ultrasound findings in pachyperiostitis include echogenic tissue surrounding the long bones&#44; reflecting the presence of edema and inflammation&#46; Doppler imaging shows increased vascularization on the surface of some superficial bony structures&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Cutaneous ultrasound is an inexpensive&#44; rapidly accessible&#44; noninvasive tool for exploring the anatomy of the nail unit&#46; In addition&#44; it is useful for distinguishing between clubbing and pachyperiostitis without the need for ionizing radiation&#46; Underlying disease must always be ruled out in such cases&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This is the first case in the literature to describe ultrasound findings in a patient with digital clubbing&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Información del artículo
ISSN: 00017310
Idioma original: Inglés
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