By Leyla H. Alparslan MDMusculoskeletal System• Radiographs can demonstrate the characteristic features of systemic sclerosis including calcinosis, loss of normal distal soft tissue and skin creases, and osteolysis that particularly involves the distal tufts.
• Computed tomography (CT) is useful in demonstrating paraspinal calcifications.
• Magnetic resonance imaging (MRI) is valuable for assessing paraspinal calcifications and their effect on neurologic structures, as well as for identifying areas of inflammatory myopathy.
Pulmonary Involvement• Radiographs may be normal in early interstitial lung disease.
• High-resolution computed tomography (HRCT) is more sensitive than radiography in the assessment of early interstitial lung disease and is able to differentiate active inflammation from fibrosis.
• Bronchoalveolar lavage (BAL) abnormalities may precede HRCT findings.
Peripheral Vascular System• Arteriography: Vasospasm and pruning of the small digital vessels are characteristic findings.
Pulmonary Hypertension and Cardiac Involvement
• On posteroanterior erect chest radiographs, the transverse diameter of the right interlobar artery should ≤16 mm. Enlargement occurs in pulmonary artery hypertension.
• Right heart catheterization optimally evaluates pulmonary arterial hypertension.
• Myocardial disease can be evaluated using radionuclide imaging, coronary angiography, or cardiac MRI.
Renal Involvement• Ultrasound and biopsy are used for exclusion of other causes of renal disease.
• Nuclear scans can demonstrate decreased renal blood flow and glomerular filtration rate.
Gastrointestinal System• Radiographs and CT may show obstruction, pseudoobstruction, volvulus, intestinal perforation, and pneumatosis cystoides intestinalis.
• Barium swallow: Esophageal dilatation, diminished or absent peristalsis in the distal two thirds of the esophagus, and a patulous gastroesophageal junction are typical features. Stricture occurs secondary to chronic gastroesophageal reflux.
• Barium follow through: Delay in transit time with decreased motility, pseudodiverticula, and hidebound appearance.
• Barium enemas are usually avoided because they may result in impaction.
• Scintigraphy: Delayed esophageal transit time and gastric emptying and gastroesophageal reflux are typical features. Delayed scans are useful for detection of pulmonary aspiration.
Available online 9 November 2009.
Musculoskeletal System
• Radiographs can demonstrate the characteristic features of systemic sclerosis including calcinosis, loss of normal distal soft tissue and skin creases, and osteolysis that particularly involves the distal tufts.
• Computed tomography (CT) is useful in demonstrating paraspinal calcifications.
• Magnetic resonance imaging (MRI) is valuable for assessing paraspinal calcifications and their effect on neurologic structures, as well as for identifying areas of inflammatory myopathy.
Pulmonary Involvement
• Radiographs may be normal in early interstitial lung disease.
• High-resolution computed tomography (HRCT) is more sensitive than radiography in the assessment of early interstitial lung disease and is able to differentiate active inflammation from fibrosis.
• Bronchoalveolar lavage (BAL) abnormalities may precede HRCT findings.
Peripheral Vascular System
• Arteriography: Vasospasm and pruning of the small digital vessels are characteristic findings.
Pulmonary Hypertension and Cardiac Involvement
• On posteroanterior erect chest radiographs, the transverse diameter of the right interlobar artery should ≤16 mm. Enlargement occurs in pulmonary artery hypertension.
• Right heart catheterization optimally evaluates pulmonary arterial hypertension.
• Myocardial disease can be evaluated using radionuclide imaging, coronary angiography, or cardiac MRI.
Renal Involvement
• Ultrasound and biopsy are used for exclusion of other causes of renal disease.
• Nuclear scans can demonstrate decreased renal blood flow and glomerular filtration rate.
Gastrointestinal System
• Radiographs and CT may show obstruction, pseudoobstruction, volvulus, intestinal perforation, and pneumatosis cystoides intestinalis.
• Barium swallow: Esophageal dilatation, diminished or absent peristalsis in the distal two thirds of the esophagus, and a patulous gastroesophageal junction are typical features. Stricture occurs secondary to chronic gastroesophageal reflux.
• Barium follow through: Delay in transit time with decreased motility, pseudodiverticula, and hidebound appearance.
• Barium enemas are usually avoided because they may result in impaction.
• Scintigraphy: Delayed esophageal transit time and gastric emptying and gastroesophageal reflux are typical features. Delayed scans are useful for detection of pulmonary aspiration.
Available online 9 November 2009.