American Journal of Roentgenology, Vol 161, 269-272, Copyright © 1993 by American Roentgen Ray Society

ARTICLES

Chest CT in patients with scleroderma: prevalence of asymptomatic esophageal dilatation and mediastinal lymphadenopathy

M Bhalla, RM Silver, JA Shepard and TC McLoud
Department of Radiology, Masschusetts General Hospital, Boston 02114.

OBJECTIVE. The high-resolution CT findings of chronic diffuse interstitial lung disease associated with scleroderma have been reported previously. This study determined the prevalence of esophageal dilatation and mediastinal adenopathy on high-resolution CT scans in patients with this disease. MATERIALS AND METHODS. We retrospectively reviewed the high-resolution CT scans of 25 patients with scleroderma who had diffuse interstitial lung disease. Esophageal dilatation was diagnosed if the esophagus below the aortic arch had a single, large, nonloculated collection of intraluminal air on four or more consecutive axial images and if the luminal diameter of such an air-filled esophagus exceeded 10 mm in the coronal plane. The presence of fluid or an air-fluid level was also considered abnormal. For mediastinal adenopathy, we used the American Thoracic Society lymph node mapping scheme and the size criteria described previously. RESULTS. Asymptomatic esophageal dilatation was detected in 20 patients (80%) and mediastinal adenopathy was present in 15 (60%). CONCLUSION. Our results suggest that CT is useful in the detection of mediastinal adenopathy and asymptomatic esophageal involvement in patients with scleroderma. These findings can be used to narrow the differential diagnosis in patients in whom CT shows diffuse interstitial lung disease. Furthermore, the early detection of esophageal involvement in these patients shows the need for treatment to forestall the complications of esophageal dysmotility and accompanying chronic gastroesophageal reflux.
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