Pulmonary echography in systemic sclerosis

F C Moazedi-Fuerst, P M Zechner, N J Tripolt, S M Kielhauser, K Brickmann, S Scheidl, A Lutfi, W G Graninger
Clinical Rheumatology 2012, 31 (11): 1621-5
In systemic sclerosis patients, interstitial lung disease and pulmonary hypertension are highly associated with mortality. The time point of detecting manifestations like pulmonary hypertension and interstitial lung disease (ILD) is of vital importance. High-resolution computed tomography (HRCT) to date is the gold standard to diagnose ILD. In addition, an ultrasound of the lung is suggested as a noninvasive and radiation-free method of structural monitoring of the lung. We tested the reliability of lung sonography for the assessment of patients with systemic sclerosis. In a pilot study involving 25 patients with systemic sclerosis and 40 healthy volunteers, we screened the pleura and the pulmonary parenchyma for sonographic abnormalities. The occurrence of B lines, comet tail phenomena, and pleural irregularities was scored. All systemic sclerosis (SSc) patients were subjected to computed x-ray tomography of the chest. Forty-four percent of SSc patients showed B line phenomena and pleural thickening. The diagnosis of ILD in these patients was confirmed by HRCT scan. B line phenomena and pleural irregularities were significantly more common in SSc patients. Patients with ILD had higher pleural scores and comet scores when compared to systemic sclerosis patients without radiographic ILD. If our results are confirmed in larger studies, transthoracic ultrasound of the lung might turn out to be a suitable method for screening patients with systemic sclerosis for incipient pulmonary structural changes.

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