Assessing digital clubbing using point-of-care US
A profile angle >176° and a hyponychial angle >192° support the diagnosis of clubbing. Practically speaking, physicians commonly rely on subjective assessments at the bedside. The increasing availability of point-of-care ultrasound (POCUS) as an adjunct to physical examination warrants a description of its use to facilitate the quantification of the profile and hyponychial angles at the bedside.

A 42-year-old woman with a 10-year history of pulmonary alveolar proteinosis was admitted to the hospital with abdominal pain. On physical examination, she was subjectively noted to have clubbing. A technique using POCUS was employed to confirm this finding.

Using the lateral water bath approach, the patient's hand was placed into a clear plastic basin filled with water, and a longitudinal view of the digit was obtained with a 14-5 MHz linear transducer.

The ultrasound images were able to demonstrate the abnormal nail-fold angles compared with a healthy control. By downloading these images and using an on-screen protractor, the patient's profile angle could be measured at 187° and the hyponychial angle at 195° compared with control angles of 169° and 180°, respectively.

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