Esophageal dilatation visible on a high-resolution CT of the lungs may be a sign of scleroderma, according to findings published in the Annals of the Rheumatic Diseases.

Esophageal dilatation visible on a high-resolution computed tomography scan of the lungs may be a sign of scleroderma, according to findings published in the September issue of the Annals of the Rheumatic Diseases.

Evidence that immunosuppressive treatment in the early stages of systemic sclerosis (SSc) may improve survival, "enhancing the need for early diagnosis and regular evaluation of organ involvement," Dr. MC Vonk, of Radboud University Nijmegen Medical Center, the Netherlands, and colleagues.

The researchers examined the predictive value of esophageal dilatation on the high-resolution computer tomography (HRCT) scan for the diagnosis of SSc. Included in the study were 105 consecutive patients with scleroderma and 107 consecutive control subjects. Two independent radiologists, who were blinded for the diagnosis of the patients, evaluated the scans for esophageal dilatation and interstitial lung disease.

Infra-aortic esophageal dilatation was observed in 62 per cent of SSc patients and 12 per cent of controls. The positive predictive value of esophageal dilatation for the diagnosis of SSc was 83 per cent and the negative predictive value was 69 per cent.

There was no difference observed in the prevalence of esophageal dilatation in patients with early disease and those with a longer duration of disease. No correlation was found between esophageal dilatation and interstitial lung disease in cases and controls.

"The presence of an esophageal dilatation on an HRCT scan does not completely predict the presence of SSc, and its absence does not rule out SSc," Dr. Vonk's team writes. "However, it could be worthwhile if a radiologist, on noticing an esophageal dilatation on an HRCT scan of the chest, reports this finding and perhaps even suggests the possibility of a diagnosis of SSc, enabling the referring specialist to start further diagnostic workup for SSc."

Ann Rheum Dis 2008;67:1317-1321