Medical Image of the Week: CREST plus ILD
Wednesday, June 5, 2013 at 7:45AM 
Figure 1. Illustrations of CREST syndrome (see below).
A 60 year old female with a history of fibromyalgia presented with dyspnea and skin changes, predominantly on the hands. Physical exam and imaging showed classic findings of limited cutaneous systemic sclerosis (scleroderma) CREST syndrome. Calcinosis cutis (Figure 1A), Raynaud’s (not shown but endorsed by the patient), Esophageal dysmotility (Figure 1B, dilated esophagus), Sclerodactyly (Figure 1C), and Teleganectasias (Figure 1D) were all present. Ground glass opacities were seen predominantly in the bilateral lower lung zones, associated with increased reticular markings (Figure 2A), and traction bronchiectasis (Figure 2B).
Figure 2. Representative images from the patient’s CT scan showing pulmonary involvement.
Pulmonary involvement is noted in the majority of scleroderma patients. Interstitial lung disease (ILD) is common and often portends a poor prognosis.
Isabel Oliva, MD and Ken Knox, MD
Division of Thoracic Imaging and Pulmonary & Critical Care Medicine
Interstitial Lung Disease Program
Reference as: Oliva I, Knox K. Medical image of the week: CREST plus ILD. Southwest J Pulm Crit Care. 2013;6(6):275-6. PDF
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