Clubbing

Clubbing is a physical examination finding where the fingernails have a club-like appearance.

Clubbing. (WC)

Causes

The causes of clubbing can be remember with mnemonic clubbing:

• Cardiac.
  • Subacute infective endocarditis.
  • Cyanotic heart disease.
  • Atrial myxoma.
• Lung:
  • Lung abscess.
  • Empyema.
  • Cystic fibrosis.
  • Idiopathic pulmonary fibrosis.
  • Tuberculosis.
  • Bronchiectasis.
  • Malignant mesothelioma.
• Ulcerative colitis.
• Biliary cirrhosis.
• Bronchogenic carcinoma (most commonly small cell).
• Idiopathic.
• Not COPD.
• Gastrointestinal:
  • Malabsorption (e.g. celiac disease).
  • Crohn disease.
  • Liver cirrhosis.

Note:

• Clubbing should be viewed with suspicion in patient with COPD, as it should not be seen in the context of pure emphysema. Clubbing in COPD is relatively rare; thus, in the context of COPD and smoking it should prompt a search for an occult lung cancer.

See also

• Physical examination.