Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Scleroderma with pulmonary involvement
- Radiologic Findings
- HRCT scan at the level of aortic arch shows mediastinal adenopathy. At ventricular level, dilated esophagus, moderate amount of pericardial effusion and pleural effusion are seen. Irregular interlobular septal thickening, subpleural honeycombing and traction bronchiectasis are predominant parenchymal changes.
Multiple bony erosion and joints involvement of hands were also seen.
Esophageal dilatation and aperistalsis were noted at barium study.
- Brief Review
- Scleroderma is a systemic collagen vascular disease of unknown cause characterized by vascular and connective tissue abnormalities. At autopsy, the lung are reportedly involved in 100% of cases of scleroderma and that is a major cause of death. HRCT findings of scleroderma are similar to those of IPF including ground-glass opacities, septal lines, traction bronchiectasis and honeycombing. Lymphadenopathy is prevalent. Enlargement of cardiac silhouette and pulmonary artery due to scleroderma induced pulmonary vascular disease also could be seen.
Observation of esophageal dilatation may help in narrowing the differential diagnosis in patients who have diffuse interstitial lung disease.
- References
- 1. Arroliga AC, Podell DN, Matthay RA. Pulmonary manifestation of scleroderma. J Thoracic Imaging, 1992, 7(2):30-45.
2. Wechsler RJ, Steiner RM, Spirn PW, et al. The relationship of thoracic lymphadenopathy to pulmonary interstitial disease in diffuse and limited systemic sclerosis: CT findings. AJR, 1996, 167(1):101-4.
3. Bhalla M, Silver, RM, Shepard, JA, McLoud TC, Chest CT in patients with scleroderma: prevalence of asymptomatic esophageal dilatation and mediastinal lymphadenopathy. AJR, 1993, 161(2):269-72.
- Keywords
- Lung, Connective tissue diseases, Systemic sclerosis,