[Ultrasound lung comets: new echographic sign of lung interstitial fibrosis in systemic sclerosis].
OBJECTIVE
Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) are common complications of systemic sclerosis (SSc). Echocardiography evaluates PAH, and chest sonography detects even mild ILC as ultrasound lung comets (ULC), i.e. multiple comet-tails fanning out from the lung surface and originating from subpleural interlobular septa thickened by fibrosis.


OBJECTIVE
to assess ILaD and PAH by integrated cardiac and chest ultrasound in SSc.


METHODS
We enrolled 30 consecutive SSc patients (age= 54+/-13 years, 23 females) in the Rheumatology Clinic of Pisa University. In all, we assessed systolic pulmonary arterial pressure (SPAP), from maximal velocity of tricuspid regurgitation flow, and ULC score with chest sonography (summing the number of ULC from each scanning space of anterior and posterior right and left chest, from second to fifth intercostal space). All patients underwent plasma assay for anti-topoisomerase antibodies (anti-Scl70), and antiicentromere associated with development of pulmonary involvement. Twenty-eight patients also underwent high resolution computed tomography, HRCT (from 0= no fibrosis to 3= honey combing).


RESULTS
ULC number - but not SPAP - was correlated to HRCT fibrosis and presence Scl-70 antibodies. ULC number was similar in localized or diffuse forms (16+/-20 vs 21+/-19, p=ns) and was unrelated to SPAP (r=0.216, p=ns).


CONCLUSIONS
Chest sonography assessment and ULC allow a complete, simple, radiation-free characterization of interstitial lung involvement in SSc - all in one setting and with the same instrument, same transducer and the same sonographer. In particular, ULC number is associated with HRCT evidence of lung fibrosis and presence of Scl-70 antibodies.
Dipartimento di Medicina Interna, U.O. Reumatologia, Università di Pisa, Pisa.
M
M
Doveri
F
F
Frassi
A
A
Consensi
E
E
Vesprini
L
L
Gargani
M
M
Tafuri
E
E
Picano
A
A
Della Rossa
A
A
Delle Sedie
A
A
d'Ascanio
C
C
Giacomelli
L
L
Bazzichi
S
S
Bombardieri
D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D001324:Autoantigens / Q000276:immunology; D002503:Centromere / Q000276:immunology; D004264:DNA Topoisomerases, Type I; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009687:Nuclear Proteins / Q000276:immunology; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000209:etiology; D011859:Radiography; D015203:Reproducibility of Results; D012595:Scleroderma, Systemic / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology; D012680:Sensitivity and Specificity; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D014463:Ultrasonography
D001323:Autoantibodies; D001324:Autoantigens; D009687:Nuclear Proteins; C048100:Scl 70 antigen, human; D004264:DNA Topoisomerases, Type I
Le comete ultrasoniche polmonari (ULC): un nuovo segno ecografico di fibrosi polmonare nella sclerodermia.