Nail clubbing

A bulbous enlargement of the distal phalanges with soft tissue overgrowth, increased Lovibond angle (>180°), loss of the normal nail bed–nail plate angle, and sponginess of the nail bed.

Causes

• Pulmonary causes

  • Lung cancer

  • Idiopathic pulmonary fibrosis

  • Cystic fibrosis

  • Bronchiectasis

  • Lung abscess

  • Chronic pulmonary infections

  • Interstitial lung disease

  • Tuberculosis

• Cardiovascular causes

  • Cyanotic congenital heart disease

  • Infective endocarditis

  • Aortic aneurysm

  • Pulmonary arteriovenous malformations

• Gastrointestinal and hepatobiliary causes

  • Liver cirrhosis

  • Inflammatory bowel disease

  • Celiac disease

  • Primary sclerosing cholangitis

  • Chronic liver disease

• Thyroid acropachy

• Primary (idiopathic) clubbing

• Familial clubbing

• Hypertrophic osteoarthropathy

• Other chronic systemic inflammatory disorders