Medical Health Encyclopedia

High frequency ultrasonography may be used to detect effects of scleroderma in patients' hands.

Diagnosing Systemic Complications

Diagnosing Lung Complications. Changes in the lungs may occur early in lung disease, and prompt treatment is critical to prevent complications. Therefore once a diagnosis is made, the physician will check for lung changes:

• Using a stethoscope the physician will first listen for specific lung sounds. Rales (a crackling sound) heard at the base of the lungs while inhaling is an indicator of pulmonary fibrosis even if breath function is normal.
• Respiratory function tests determine lung capacity.
• A chest x-ray is usually performed. X-rays, however, do not always detect lung disease, particularly in children.
• Patients also are often asked to inhale nitric oxide to test the ability of blood vessels to open. (According to a small 2002 study, this test may cause complications in patients with CREST syndrome, who should be tested with caution.)
• More extensive tests, notably high resolution computed tomography (CT) scans and bronchoalveolar lavage, may be needed if severe lung scarring is suspected.

Right heart catheterization involves the passage of a catheter (a thin flexible tube) into the right side of the heart to obtain diagnostic information about the heart and for continuous monitoring of heart function in critically ill patients.

Diagnosing Heart Complications. Patients with suspected heart involvement should have electrocardiography, echocardiography, or radionucleotide ventriculography. Advanced imaging techniques, such as single photon emission tomography (SPET), may also be useful to determine the extent of heart involvement in scleroderma patients.

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Diagnosing Pulmonary Hypertension. Echocardiography is a noninvasive imaging technique for detecting pulmonary hypertension, a common and life-threatening complication of scleroderma. An invasive procedure called right-heart catheterization is often used to confirm the diagnosis. However, a newer, noninvasive technique called cardiac MRI is now becoming available at many centers. Studies have shown that cardiac MRI is more accurate than either echocardiography or right heart catheterization.