Scleroderma

This is a 42 year old woman who presented with shortness of breath and pain in her fingers. Frontal and lateral radiographs of the chest were obtained. The red arrow on the frontal radiograph corresponds to a column of air within a dilated esophagus. The green area corresponds to interstitial thickening at the right lung base. The lateral radiograph nicely demonstrates air within a dilated esophagus. The red arrow points to dilation of the gastroesophageal junction. A dilated esophagus can be seen with many entities including achalasia, pseudoachalasia, and esophageal strictures. However, given the interstitial changes in the lower lobes as well as the clinical history of finger pain, the findings are most consistent with scleroderma. Scleroderma affects the smooth musle of the esophagus leading to dilatation and deficiency of the gastroesophageal junction. Patients with scleroderma not uncommonly develop interstitial lung disease.