title: Radiological thymus alterations in systemic sclerosis: our experience and a review of the literature.
abstract: OBJECTIVE
  Thymus alterations have been related to several autoimmune disorders. In particular, previous studies identified a significant frequency of gland abnormalities by chest high-resolution CT (HRCT) in SSc patients. In this study we aimed to investigate the prevalence of radiological thymic alterations and their correlation with clinical and serological features in a large SSc series.
  
  
  METHODS
  We retrospectively evaluated thymic shape on CT scans of 200 consecutive, unselected SSc patients aged over 30 years The presence of radiological abnormalities, i.e. enlarged gland >13 mm or nodular lesions >7 mm, was correlated with SSc clinico-serological features. Moreover, the patients were also classified using a second thickness cut-off of 7 mm in order to identify incomplete thymic involution.
  
  
  RESULTS
  Twenty-four of 200 (12%) SSc patients presented an abnormal thymus at HRCT, including hyperplasic (19/24) and nodular (5/24) glands. Otherwise, using the cut-off of 7 mm for gland thickness and excluding subjects with nodular thymus, 50/195 (25.6%) patients presented an incomplete thymic involution. Thymic radiological alterations are significantly correlated with younger age and diffuse cutaneous SSc. Moreover, an abnormally enlarged thymus tended to be more common in patients with shorter disease duration.
  
  
  CONCLUSIONS
  The present report on a large series of SSc patients further reinforces previous data present in the literature that includes other cohort studies and a number of anecdotal observations. Even though the actual role of thymus radiological abnormalities remains unclear, possible involvement of the gland in the early phase of immune-mediated SSc pathogenesis might be supposed.
authors.affiliation: Rheumatology Unit, University of Modena & Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41100 Modena, Italy. michelecolaci@virgilio.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Colaci
authors.forename: Dilia
authors.initials: D
authors.lastname: Giuggioli
authors.forename: Andreina
authors.initials: A
authors.lastname: Manfredi
authors.forename: Caterina
authors.initials: C
authors.lastname: Vacchi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Della Casa
authors.forename: Clodoveo
authors.initials: C
authors.lastname: Ferri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology; D013950:Thymus Gland / Q000000981:diagnostic imaging*; D013952:Thymus Hyperplasia / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D001323:Autoantibodies
keywords: scleroderma; systemic sclerosis; thymic hyperplasia; thymus