A roentgenological study of progressive systemic sclerosis

Abstract

Progressive systemic sclerosis (P.S.S.) is one of the collagen diseases which involves not only the skins but also various organs e.g. bones, heart, lungs, gastro-intestinal tract and others. The present study was carried out for the further evaluation of the radiological changes on thirty-five patients which clinically diagnosed and histologically verified P.S.S. during the period of May, 1964 to May, 1982 at Nippon Medical School Hospitals and Chichibu Hospital. The frequency of various radiological changes in the hands, thoraces and gastro-intestinal tract were analysed and following results were obtained.1) Bone atrophy and narrowing of the finger joints were more frequent, which was seen in 16/33 cases (48.4%) of these patients. The absorption of turfts of the terminal phalanges was noted in 11/33 cases (33.3%). Soft tissue calcifications were seen in 8/33 cases (22.8%).2) Measurement of right 2nd fingertips revealed shortening of vertical length of terminal phalanges in 4/17 cases (23.5%).3) Bilateral diffuse fibrosis especially in the lower lung fields, with or without small cystic change, was seen in 22/35 cases (62.0%).4) Cardiomegaly was seen in 15/35 cases (42.8%), two of whom had pericardial effusion.5) An upper gastro-intestinal study demonstrated diminished peristalsis of the esophagus in 21/35 cases (60.0%). Fourteen patients had air shadows in the plain chest films termed as "air esopha-gram".6) The barium meal retention and dilatation in the duodenal loops was noted in 22/35 cases (62.8%).7) Dilatation and diminished peristalsis of the small intestine were the most frequent and occured in 25/35 cases (71.4%), these findings were more significantly noted in the jejunum than ileum. The widest diameter of the small bowel was measured and the diameter of the jejunum was over 30mm in 18/25 cases (72.0%), while in the ileum it was over 25mm in 14/25 cases (56.0%).In conclusion, the present results suggest that awareness of roentgenological fidings in these patients gives us greater opportunity for the correct diagnosis in everyday practice.