Radiological findings in gastrointestinal scleroderma

Abstract

Gastrointestinal involvement is the most common visceral organ manifestation in systemic sclerosis. Symptoms from the gastrointestinal tract are very frequent among scleroderma patients and in many cases present a therapeutic challenge. However, gastrointestinal involvement may also be asymptomatic, presenting with complications later in the disease course. Early recognition of gastrointestinal scleroderma is therefore important both for symptomatic control and prevention of complications. Gastrointestinal imaging alongside clinical assessment forms the mainstay of diagnosis. Radiological investigations, traditionally plain radiographs and barium studies, with the more recent advances in computed tomography, magnetic resonance imaging and ultrasound, provide means for accurate evaluation of visceral organ involvement and more effective patient care. Awareness of the characteristic images is important not only for radiologists but also for the treating physicians and gastroenterologists.

Pneumatosis Intestinalis, Pneumoperitoneum, and Ascites Secondary to Scleroderma: A Case Report

“…Disruption of these muscle fibers due to fibrosis leads to progressive atrophy and collagenous replacement. This furthers the damage seen in the circular smooth muscle layer, with increased GI tract dysmotility [5][6][7]. Progression of SSc can lead to episodes of pseudo-obstruction.…”

“…How enhanced fibrosis affects the alimentary tract and results in various outcomes is depicted in Figure 5. Outcomes include dysmotility, thinning/ulceration, and malabsorption [5][6][7].…”

Imaging More than Skin-Deep: Radiologic and Dermatologic Presentations of Systemic Disorders

“…Dermal thickness has been shown to be inversely corelated with blood perfusion. Additionally, US elastography has been shown to be of value in the evaluation of the skin in SSc [ 23 , 25 , 26 , 27 , 28 , 29 ]. Claw hands ( Figure 3 A), thin lips, sharp nose, and a characteristic “mouse face” appearance can result from this [ 23 ].…”

“…Esophageal dilation and shortening below the level of the aortic arch can be seen on the classic chest radiograph. Dilated tubular esophagus without peristalsis with gastro-esophageal junction widening and contrast medium regurgitation back to the esophagus may be seen on barium swallow [ 29 ].…”

“…Erosion and punctuate areas of bone destruction primarily involve the anterior ethmoidal region and is best visualized by CT [ 35 , 36 ]. Saddle nose deformity and perforation of the nasal septum can be present ( Figure 5 D) [ 29 ]. In 6% of patients, contiguous spread of inflammation can lead to the involvement of the skull base, resulting in cranial neuropathy, and is seen as cranial nerve enhancement and thickening on MRI [ 35 , 36 ].…”