Illustrations demonstrating the hypothesized mechanisms underlying the pathogenesis of HOA in congenital heart disease with right-to-left shunt (a) due to failure to fragment platelet precursors within the pulmonary circulation or with pleural or pulmonary disease (b) resulting in the release of growth factors and trophic effects on capillary beds, in both cases promoting vascularity and stimulation of fibroblasts and osteoblasts, and leading to periostitis and finger clubbing. | Yap, F. Y., Skalski, M. R., Patel, D. B., Schein, A. J., White, E. A., Tomasian, A., … Matcuk, G. R. (2016). Hypertrophic Osteoarthropathy: Clinical and Imaging Features. RadioGraphics, 37(1), 157–195. https://doi.org/10.1148/rg.2017160052

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