Age / Sex : 50 / F

Chief complaint: ulceration of finger tips for 3 months

What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(답안은 한 개만 보내주시기 바랍니다)

Courtesy: 박정미 (Jeongmi Park), 가톨릭대학교 여의도성모병원 (Yeouido St. Mary’s Hospital)

systemic sclerosis (scleroderma) with acroosteolysis & periarticular calcification

Discussion

Findings:

Both hand AP:

Loss of soft tissues and resorption of distal phalanges of first through fifth digits of right hand & first digit of left hand.

Periarticular amorphous calcifications in the R ulnocarpal joint margin.

Chest Ct with lung window :

Calcific nodules between the left scapula and chest wall. Diffuse smooth interlobular septal thickenings in both lung due fibrosis related to underlying systemic sclerosis

Differential Diagnosis:

Psoriasis, hyperparathyroidism, dermatomyositis, leprosy, hyperparathyroidism, end stage renal disease

Diagnosis: systemic sclerosis (scleroderma)

Discussion:

Scleroderma is a connective disorder of unknown etiology, characterized by thickening and fibrosis of the skin, can be classified into disease restricted to the skin and systemic disease with visceral organ involvement (systemic sclerosis).

Skin involvement is the hallmark through three phases: edematous, indurative, and atrophic. Soft tissue resorption is frequently accompanied by calcific deposits and bone resorption of the finger tip.

Calcinosis (abnormal deposition of calcium salts in the body tissue) occurs in about 25 % of patients with scleroderma. The cutaneous, subcutaneous, and periarticular calcification is composed of calcium hydroxyapatite crystal deposits.

Pulmonary manifestation is interstitial lung disease, pulmonary hypertension, alveolar hemorrhage, aspiration pneumonitis, and pleural disease. Interstitial lung disease is the most common pulmonary complication of systemic sclerosis with wide spread, symmetric basally predominant reticulonodular pattern.,

References:

Imaging of Arthritis and Metabolic bone disease

 2009 by Saunders, Elseview  Barbara N . Weissman

Avouac J, Guerini H, Wipff J et-al. Radiological hand involvement in systemic sclerosis. Ann. Rheum. Dis. 2006;65 (8): 1088-1092.