a 51 year-old female with dysphagia and shortness of breath. What's the most likely diagnosis?





I think systemic sclerosis patient would have manifested otherwisw Commonly present with skin thickening and burning sensation in skin with intense itching these are late manifestation. To me it seems patient is in immunocompromised state most likely due to HIV leading to oesophageal candidiasis and Lrti on the background of HIV Second possibility of otner syndrome Dysphagia secondary to LA enlargement compressing esophagus due to mitral stenosis or aortic stenosis hence pulmonary congestion

Yes agree with you dear Nitin

Systemic sclerosis ??

ILD most probably scleroderma

ILD Rule out scleroderma

Bilateral honey combing in both mod and lwr zns As per cc it is iLD

Dysphagia is in explainable for me

Scleroderma of the Lungs Progressive Systemic Sclerosis General Considerations Multisystem collagen vascular connective tissue disease mediated by a vasculitis Unknown etiology Most common form 30-50 Female to male ratio of 3:1 Pulmonary manifestations in 10-25% of patients with scleroderma, but& Lungs are involved in almost 100% of cases at autopsy Clinical Findings Mildly productive cough Progressive dyspnea Hematemesis Pulmonary function abnormalities out of proportion to radiographs Imaging Findings High resolution CT (HRCT) is best imaging study Chest radiographs can be insensitive to the presence of pulmonary disease and show abnormalities in only about 2/3 of patients with lung involvement Most prominent at lung bases bilaterally Interstitial disease which is primarily reticular Subpleural fibrocystic spaces (honeycombing) Low lung volumes from progressive volume loss Aspiration of refluxed gastric contents from disturbed esophageal motility Associated esophageal dilatation HRCT findings Pulmonary fibrosis and hypertension are most frequent findings Subpleural linear opacities with a basal distribution Subpleural cysts (honeycombing favors UIP) Irregular reticular opacities Septal thickening Traction bronchiectasis Thickening of the visceral pleural Micronodules Pleural disease including effusion is very uncommon in scleroderma Differential Diagnosis Idiopathic pulmonary fibrosis Asbestosis Rheumatoid lung Complications May be associated with systemic lupus erythematosis and dermatomyositis Pulmonary arterial hypertension Slightly increased incidence of lung cancer Sclerosis of cardiac muscle may contribute to cor pulmonale Prognosis Overall: 50-67% 10-year survival rate Lung disease is leading cause of death from scleroderma.

Thank you for the explanation, sir
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