Clubbing due to Peripheral Hypervascularization
Recognition by Contrast-Enhanced, Three-Dimensional Magnetic Resonance Angiography
A 23-year-old medical student presented with slowly progressive swelling of the terminal digits that had a duration of 3 years (Figure 1).
There was no family history of clubbing or cyanosis. The patient had no signs of cyanosis or a history of cardiac, pulmonary, or inflammatory bowel disease. His physical activity, including field sports and regular workouts, was unlimited. On examination, he had normal cardiac, lung, and abdominal findings. Furthermore, lung function tests, electrocardiography, Doppler echocardiography, and chest x-ray revealed normal results. Laboratory tests, including vasculitis-associated antibodies and thyroid function, also produced normal results.
Contrast-enhanced 3D magnetic resonance angiography of the left hand showed no evidence of arterial stenosis, arteriovenous shunting, or vasculitis. However, there was marked hypervascularization in the terminal digits (Figure 2), reflecting a potential source of clubbing.
This example demonstrates the potential of magnetic resonance angiography for diagnostic visualization of vascular abnormalities, without performing invasive arterial catheterization or applying ionized radiation.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.