Transthoracic lung ultrasound in the monitoring of interstitial lung disease: a case of scleroderma.

A 51‐year‐old woman with a diagnosis of intersti‐ tial lung disease within scleroderma was admitted to the Department of Internal Medicine, Connec‐ tive Tissue Disease and Geriatrics, Medical Univer‐ sity of Gdansk, Poland. The goal of this study was to compare monitoring of lung lesions in intersti‐ tial lung disease by transthoracic lung ultrasound (TLUS) to monitoring by high‐resolution comput‐ ed tomography (HRCT), before and after treatment with cyclophosphamide. The patient was hospi‐ talized because of gradually increasing exertional dyspnea. Positive findings in the physical exami‐ nation were: exertional dyspnea, asymmetric rales at the base of both lungs, joint pain (VAS7), digital edema, sclerodactylia, microstomia, telangiectasia, and Raynaud’s phenomenon. Percutaneous oxy‐ gen saturation during moderate exercise was low (88%) while normal was at rest (95%). Immune test results included positive antinuclear antibodies Hep‐2 antibodies (1:10 240, light type nucleolar) and markedly positive Scl‐70 antibodies. Pulmo‐ nary function tests reported a reduction in diffus‐ ing capacity of the lung for carbon monoxide (60%). The first HRCT study showed fibrotic lesions, main‐ ly in the lower lobes, and ground‐glass opacity in the middle fields of the lungs (FIGURE A1, B1). TLUS CLINICAL IMAGE