Progressive Systemic Sclerosis: Using HighResolution CT to Detect and Characterize Interstitial Lung Disease in Siriraj Hospital

Objective: To detect and characterize interstitial lung disease in patients with progressive systemic sclerosis in Siriraj Hospital using high-resolution computed tomography (HRCT) and to detect other associated findings in the chest. Methods: Retrospective reviewed chest radiography and HRCT of twenty patients with progressive systemic sclerosis during January 2000- January 2005. The HRCT scans were reviewed by two radiologists for reticular opacities (interlobular septal thickening, traction bronchiectasis, honeycombing and bronchovascular interstitial thickening), nodular pattern (miliary, centrilobular and perilymphatic nodule), consolidation and ground-glass opacities. The associated findings in the chest such as esophageal dilatation, mediastinal lymphadenopathy and main pulmonary artery enlargement were also evaluated. Results: Chest radiography detect interstitial lung disease in eighteen patients (90%). The findings are reticular opacities and fibrosis at both lower lobes. The HRCT shows interstitial lung disease in twenty patients (100%) with the greatest proportion of interlobular septal thickening (85%), followed by traction bronchiectasis (75%), honeycombing (40%) and ground-glass opacities (25%). The distribution of disease is peripheral and lower lung predominant. The associated findings: esophageal dilatation and mediastinal lymphadenopathy were presented in 55% of patients and main pulmonary artery enlargement was presented in 90% of patients. Conclusion: HRCT is more sensitive than chest radiography for detecting and characterize interstitial lung disease in patients with progressive systemic sclerosis. Our study has evidences of interstitial lung disease in all patients with greatest proportion of interlobular septal thickening, followed by traction bronchiectasis, honeycombing and ground-glass opacities. Moreover HRCT can recognize cases with predominance of inflammatory process and direct clinician into more aggressive treatment, may be benificial in preventing irreversible disease. HRCT was useful for detecting other associated findings in the chest such as esophageal dilatation, mediastinal lymphadenopathy and main pulmonary artery enlargement