Systemic sclerosis

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This female patient has been complaining of non-specific upper abdominal symptoms.

Patient Data

Age: 40
Gender: Female

Upper GI barium study

Modality: Barium

Double contrast barium swallow. The upper and mid-sections of the oesophagus are patulous and again show severe dysmotility. There is smooth tapering towards the gastro-oesophageal junction. No convincing stricture. No mucosal abnormality.

Radiographs of both hands

Modality: X-ray

Radiographs of both hands show abnomal alignment of the metacarpophalangeal joints, most marked on the left, in keeping with subluxation. The bone density appears normal. There is joint space loss and evidence of erosive arthropathy particularly evident at the metacarpophalangeal joinft of the right long finger. Dense soft tissue calcifications are seen in the finger tips and along the ulnar aspect of the right wrist/distal forearm.

Case Discussion

The main abnormality here is severe oesophageal dysmotility. Other typical features shown here are the patulous oesophagus, smooth tapering, patulous duodenum and delayed duodenal/gastric emptying. Severe reflux was also demonstrated (no images). The gastro-oesophageal junction measured 1.5cm. This is borderline normal, and ballon dilatation is usually considered with a cut-off of 1.3cm. 

Companion radiographs of both hands in this patient show typical dystrophic soft tissue calcifications and arthropathy as described.

See also

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Case Information

rID: 23125
Case created: 23rd May 2013
Last edited: 7th Dec 2016
Inclusion in quiz mode: Included

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