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Case ReportImages in Rheumatology

Abdominal Radiograph in Systemic Sclerosis

UEI PUA
The Journal of Rheumatology March 2009, 36 (3) 654; DOI: https://doi.org/10.3899/jrheum.080985
UEI PUA
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Systemic sclerosis can give rise to many findings in the abdominal radiograph. Detection of lung base changes together with “sheet-like” soft tissue calcification and large bowel ileus are important clues to a unifying diagnosis of systemic sclerosis.

A 51-year-old woman presented with a history of several months’ duration of abdominal distension and constipation. The abdominal radiograph (Figure 1) showed evidence of large-bowel dilatation of the transverse colon, with normal mucosal features and fecal loading in the sigmoid and rectum. Additionally, there was evidence of florid soft-tissue calcification involving bilateral iliacus muscles. The lung bases showed reticular shadowing with pleural thickening, consistent with pulmonary fibrosis. The constellation of signs — muscle calcifications1, pulmonary fibrosis2, and nontoxic megacolon3 — indicates systemic sclerosis, with bowel atony accounting for the patient’s presentation. The hand radiograph (Figure 2) shows the classic appearance of systemic sclerosis — distal phalanx resorption with soft-tissue calcinosis.

Figure 1.
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Figure 1.

The abdominal radiograph shows evidence of dilatation of the transverse colon, with normal mucosal features (arrowheads) and fecal loading.

Figure 2.
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Figure 2.

Hand radiograph shows the classic appearance of systemic sclerosis — distal phalanx resorption with soft-tissue calcinosis.

Footnotes

REFERENCES

  1. 1.↵
    1. Ringel RA,
    2. Brick JE,
    3. Brick JF,
    4. Gutmann L,
    5. Riggs JE
    . Muscle involvement in the scleroderma syndromes. Arch Intern Med 1990;150:2550–2.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Kaloudi O,
    2. Miniati I,
    3. Alari S,
    4. Matucci-Cerinic M
    . Interstitial lung disease in systemic sclerosis. Intern Emerg Med 2007;2:250–5.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Brandwein M,
    2. Schwartz IS
    . Megacolon and volvulus complicating progressive systemic sclerosis. Mt Sinai J Med 1988;55:343–5.
    OpenUrlPubMed
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The Journal of Rheumatology
Vol. 36, Issue 3
1 Mar 2009
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Abdominal Radiograph in Systemic Sclerosis
UEI PUA
The Journal of Rheumatology Mar 2009, 36 (3) 654; DOI: 10.3899/jrheum.080985

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UEI PUA
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