Scleroderma - Diagnosis

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Highlights	Diagnosis	Treatment for Lung Complications
Introduction	Treatment	Treatment for Gastrointestinal Problems
Symptoms	Medications	Treatment for Other Complications
Causes	Other Treatments	Resources
Risk Factors	Treatment for Raynaud's Phenomenon	References
Prognosis	Treatment for Skin Thickening

Ultrasound

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

Diagnosing Systemic Complications

Diagnosing Lung Complications. Changes in the lungs may occur early in scleroderma lung disease, and prompt treatment is very important to prevent complications. For this reason, once a diagnosis is made, the doctor will check for lung changes:

Using a stethoscope, the doctor will first listen for specific lung sounds. Rales (a crackling sound) heard at the base of the lungs while breathing in is a sign of pulmonary fibrosis even if breath function is normal.
Respiratory function tests determine lung capacity.
A chest x-ray is usually done. X-rays, however, do not always find lung disease, especially in children.
In another test, patients 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, such as 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 complications should have the following tests:

Electrocardiography (ECG): A test of the heart's electrical activity
Echocardiography: A look at the beating heart through the use of sound waves
Radionucleotide ventriculography: An evaluation of the working heart using a radioactive dye

Advanced imaging techniques, which provide a more detailed picture of the heart, may also be useful to determine the extent of heart complications in scleroderma patients.

Diagnosing Pulmonary Hypertension. Echocardiography is a noninvasive imaging technique for detecting pulmonary hypertension, a common and life-threatening complication of scleroderma. (A non-invasive procedure is one where no materials or equipment are put into the body.) To confirm the diagnosis, doctors sometimes use an invasive procedure called right-heart catheterization. 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.