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Symptoms and Signs – Differential Diagnosis of Clubbing • Celiac disease • Chronic liver disease, cirrhosis (particularly biliary and juvenile) • Chronic trauma (jackhammer operators, machine workers) • Cyanotic congenital heart disease • Cystic fibrosis • Endocrine (Graves’ disease, hyperparathyroidism) • Extrapulmonary infectious process (subacute bacterial endocarditis, intestinal TB, bacterial or amebic dysentery, arterial graft sepsis) • Hereditary (pachydermoperiostitis) • Idiopathic • Inflammatory bowel disease (IBD) • Other neoplasm (GI, liver, Hodgkin’s disease, thymus, osteogenic sarcoma) • Pneumoconiosis • Pulmonary arteriovenous (AV) malformations • Pulmonary infectious process (empyema, abscess, bronchiectasis, TB, chronic pneumonitis) • Pulmonary neoplasm (lung, pleura) • Sarcoidosis • Thyroid acropachy 
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