Clubbing

Causes of bilateral clubbing include:

• Pulmonary causes (around 75% of cases) 
• Cancer 
• Mesothelioma 
• Abscess
• Empyema (chronic) 
• Cystic fibrosis 
• Bronchiectasis 
• Pneumonitis (chronic) 
• Cardiac causes (around 15% of cases)
• Atrial myxoma
• Cyanotic congenital heart disease
• Endocarditis
• GI causes (5 to 10% of cases) 
• Cirrhosis 
• Carcinoma/lymphoma 
• Inflammatory bowel disease
• Other (5 to 10% of causes)
• Hyperthyroidism 
• Pregnancy 
• Some toxins 

Unilateral finger clubbing consider:

• Pancoast tumour
• Aortic/subclavian artery aneurysm 

 

Small print gem: clubbing of toes without finger clubbing suggests coarctation of the aorta

References:

McPhee, S. Clubbing. In Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 44.

Reymen, K. and Daniel, W. Images in clinical medicine. Idiopathic clubbing. N Engl J Med. 2000; 343(17): 1235.