Pulmonary Manifestation in Systemic Sclerosis in Srinagarind Hospital
Chanita Unhapipatpong MD1, Ajanee Mahakkanukrauh MD1, Chingching Foocharoen MD1, Siraphop Suwannaroj MD1, Ratanavadee Nanagara MD1, Panaya Tumsatan MD2
Affiliation : 1 Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Thailand 2 Radiology Department, Faculty of Medicine, Khon Kaen University, Thailand
Background : Systemic Sclerosis [SSc] can involve any organ systems, including pulmonary system which was associated
with high mortality in SSc. Direct and indirect pulmonary complications can occur.
Objective : To define the radiographic differences from HRCT chest between the patients with diffuse cutaneous systemic
sclerosis [dcSSc] and limited cutaneous systemic sclerosis [lcSSc]. Also, to find out the indications for HRCT chest testing
and factors that may involve the patterns of pulmonary involvement.
Materials and Methods : A historical cohort study collected all adult SSc patients who were followed-up at Scleroderma
Clinic in Srinagarind Hospital during 1 January 2012 until 30 November 2014 and had performed high resolution computed
tomography [HRCT] of chest. Any indications of HRCT chest and clinical manifestations of patients were review.
Results : A total of 289 patients underwent HRCT chest, 229 (79.2%) were dcSSc. Median age and disease duration at time
of first performing HRCT chest were 53 and 1 year, respectively. The female to male ratio was 2.2: 1. Abnormal chest
radiography was the most common indication of HRCT chest (179; 61.94%), followed by abnormal chest symptoms (121;
41.87%). The most common findings in HRCT chest in both SSc subsets were septal thickening (79.9%), followed by
mediastinal lymphadenopathy (59.2%). There was no statistical significance of pattern of pulmonary involvement in both
dcSSc and lcSSc. Screening in asymptomatic patients for pulmonary involvement by HRCT chest was significant higher in
lcSSc than in dcSSc (p<0.05). Ground glass opacity was revealed in 31.3% in asymptomatic patients who were screened
HRCT.
Conclusion : There were no differences in pattern of pulmonary involvement between both SSc subsets. SSc associated
interstitial lung disease and mediastinal lymphadenopathies were common findings in Thai SSc patients. One-third of the
patients had ground glass opacity by HRCT chest despite of being asymptomatic.
Keywords : Systemic sclerosis, High resolution computed tomography, Pulmonary manifestation, Interstitial lung disease, Mediastinal adenopathy, Esophageal dilatation
