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Sclerodactyly differential diagnosis

Differential diagnosis is complicated by the fact that several pseudosclerodermas can imitate scleroderma beyond the sclerodactyly and telangiectasia) is now included as a subtype of ISSc. More than 60 % of patients present with the find-ings of ISSC. Classically, these patient Differential diagnosis is complicated by the fact that several pseudosclerodermas can imitate scleroderma beyond the symptom of sclerosis of the skin, and that, in rare cases, visceral scleroderma can occur without sclerosis of the skin [ 4 ]

Scleroderma-like disorders (e.g., eosinophilic fasciitis, scleromyxedema, nephrogenic fibrosis, scleredema) need to be considered in the differential diagnosis of scleroderma overlaps. Several fibrotic conditions may mimic scleroderma (see Table 86-2) CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome is a member of the heterogeneous group of sclerodermas, and its name is an acronym for the cardinal clinical features of the syndrome. In 1910, Thibierge and Weissenbach described the first case report of what was later called CRST (calc.. There is a lack of Raynaud phenomenon, sclerodactyly, or visceral manifestations. INVESTIGATIONS. Abnormal CXR, pulmonary function tests, barium swallow make the diagnosis of scleroderma more likely than localized scleroderma (morphea). Diagnosis is clinical. Mixed connective tissue disease. SIGNS / SYMPTOMS Abstract The clinical differential diagnosis of hard skin can be divided into two main diagnostic categories: morphea and morphea-like conditions and systemic sclerosis and sclerodermoid conditions. Patients with morphea and morphea-like conditions tend to have more asymmetric, discontinuous skin involvement, while patients with systemic sclerosis and sclerodermoid conditions tend to.

Differential diagnosis of scleroderma and pseudoscleroderm

Global Skin Atlas - Diagnosis Detail

Scleroderma Differential If Morphea Lichen sclerosus (often genital, can coexist) If Telangiectasias Osler-Weber-Rendu (nasal bleeds, no sclerosis) If Sclerodactyly Porphyria cutanea tarda (bulla, photosensitive, hypertrichosis [RHEOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS BETWEEN RAYNAUD'S DISEASE AND SCLERODACTYLY]. [Article in Italian] CALIFANO A. PMID: 14209906 [PubMed - indexed for MEDLINE] MeSH Terms. Diagnosis, Differential* Electric Impedance* Humans; Plethysmography* Plethysmography, Impedance* Raynaud Disease* Scleroderma, Localized* Scleroderma, Systemic In patients who are negative for the ANA, other differential diagnoses shall be ruled out before confirming the diagnosis of SSc. Other more specific autoantibodies are positive in 60 to 70% of cases of SSc. These more specific autoantibodies are mutually exclusive and can be present several months to years before the clinical diagnosis of SSc CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome is a member of the heterogeneous group of sclerodermas, and its name is an acronym for the..

Differential diagnosis of scleroderma and

Differential diagnosis of skin calcinosis encompasses Thibierge-Weissenbach syndrome, systemic sclerosis, scleroderma, CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia), dermatomyositis, systemic lupus erythematosus, ad myositis ossificans progressiva A variety of systemic disorders—infections, noninfectious inflammatory diseases, collagen vascular diseases, hereditary diseases, and acquired immune deficiency diseases—may affect both the skin and the lung. The findings in one organ system can help establish the diagnosis or limit the differential diagnosis An award-winning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, GI, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, hand-out notes, interactive material, most commons lists and pictorial differential diagnose Sclerodactyly, a condition in which the skin becomes thin, shiny, and bright, results in decreased function of the fingers and toes. Telangiectasia, the appearance of small blood vessels near the surface of the skin, usually on the face, hands, and in the mouth, is unsightly but not debilitating Key Differential Diagnosis Issues. • Align transducer obliquely to obtain views not obscured by calcification. • Differential diagnoses. Clinical history, e.g., trauma more in favor of fat necrosis, panniculitis, or myositis ossificans (MO) Radiographs ± CT findings are helpful for analyzing type of calcification

Huriez syndrome (palmoplantar hyperkeratosis-sclerodactyly syndrome) POEMS syndrome; Palmoplantar keratosis - congenital alopecia, autosomal recessive (cataract - alopecia - sclerodactyly) Sharp syndrome (mixed collagenosis) Celiac disease; and still questionable new syndromes. Differential diagnosis. The following are to be distinguished Differential Diagnosis & Pitfalls Drug-induced scleroderma shares clinical findings of localized and systemic sclerosis and thus a similar differential should be considered. ANA negative, no sclerodactyly, no Raynaud phenomenon. Stiff-skin syndrome - Characteristic sparing of the hands and feet,. PSC should be differentiated from secondary causes of sclerosing cholangitis and IgG4-associated cholangitis. Another potential differential diagnosis for this case was antimitochondrial antibody negative PBC as antimitochondrial antibody may be negative in less than 10 % of cases [ 9 ] Sclerodactyly with acroosteolysis (AO) and calcinosis are prominent features of systemic sclerosis (SSc), but the pathogenesis of these findings is poorly understood [ncbi.nlm.nih.gov] Due to excess formation of scar tissue, blood flow to the extremities is decreased, primarily to the hands, and tissues often become hypoxic, resulting in.

Differential Diagnosis In the context of the history and physical exam, systemic sclerosis was high on the differential given the following manifestations: constitutional symptoms, sclerodactyly [the-rheumatologist.org The differential diagnosis of calcinosis cutis includes: Milia (which will be differentiated based on the type of material expressed and histopathology) Calciphylaxis (which is more likely to be painful, on the lower extremities, and be associated with livedo mottling and calcification of subcutaneous blood vessels Bone marrow, other histology or imaging tests may distinguish the diagnosis. Autoantibodies will be negative. Difficult to differentiate clinically if no other symptoms or signs associated with SLE are present (e.g., Raynaud, rash). Antibodies for dsDNA may be positive if SLE is the cause These criteria are applicable to any patient considered for inclusion in a systemic sclerosis study. The criteria are not applicable to patients with skin thickening sparing the fingers or to patients who have a scleroderma-like disorder that better explains their manifestations (e.g., nephrogenic sclerosing fibrosis, generalized morphea, eosinophilic fasciitis, scleredema diabeticorum.

Sclerodactyly - an overview ScienceDirect Topic

  1. Diffuse Skin Thickening, Joint Stiffness, Myalgias: What Is the Diagnosis? A man presents with myalgias, skin thickening in his arms, legs and abdomen and stiffness in his joints. The Director of the Scleroderma Program develops the differential
  2. Case of generalized morphea with the manifestation of diffuse systemic cutaneous sclerosis without sclerodactyly J Dermatol . 2018 May;45(5):e100-e101. doi: 10.1111/1346-8138.14155
  3. For differential diagnosis, the presence of Raynaud phenomenon, antinuclear antibodies and the distribution of sclerosis play essential roles. Diabetic sclerodactyly is characterized by a.
  4. There is a lack of Raynaud's phenomenon, sclerodactyly, or visceral manifestations. INVESTIGATIONS. Abnormal CXR, pulmonary function tests, barium swallow make the diagnosis of scleroderma more likely than localised scleroderma (morphoea). Diagnosis is clinical. Mixed connective tissue disease. SIGNS / SYMPTOMS
  5. Differential Diagnosis & Pitfalls. CREST syndrome; Generalized morphea - Asymmetric induration, no Raynaud phenomenon, no systemic involvement. Scleredema - ANA negative, no Raynaud phenomenon, no systemic involvement. Scleromyxedema - ANA and anticentromere negative, no Raynaud phenomenon, no sclerodactyly. Generalized myxedem

CREST Syndrome Differential Diagnoses - Medscap

  1. Differential Diagnosis [edit | edit source] A number of other diseases have symptoms similar to those seen in scleroderma. These include: Eosinophilic fasciitis (EF): This rare disease involves the fascia, the thin connective tissue around the muscles. The fascia becomes swollen, inflamed and thick
  2. Comparisons may be useful for a differential diagnosis: Mixed connective tissue disease (MCTD) is a rare inflammatory disorder of the connective tissue. Raynaud's phenomenon, esophageal dysfunction, sclerodactyly and telangiectasia. Calcinosis is the abnormal accumulation of calcium salts under the skin and in many other organs. Raynaud.
  3. Dermatologic and musculoskeletal signs of connective tissue disease, including skin rashes, sclerodactyly, skin thickening, digital ulceration, mechanic's hands, synovitis, joint deformities, Raynaud's phenomenon, and telangiectasias, may be extremely helpful in narrowing the differential diagnosis
  4. Mixed connective tissue disease (MCTD) is an autoimmune, rheumatic disease with clinical features overlapping systemic lupus erythematosus (SLE), polymyositis, and systemic sclerosis, and associated with anti‐U1 RNP (ribonucleoprotein) antibodies. Four classification criteria are published, but these are not validated in children
  5. The main differential diagnosis of scleromyxedema includes the following entities: 1) scleroderma (systemic sclerosis); 2) scleredema; and 3) nephrogenic systemic fibrosis. The presence of diffuse waxy papules in linear arrays and in a characteristic distribution on the glabellum and posterior auricular area and the IgG monoclonal gammopathy.

S Sclerodactyly, thickening and tightening of the skin on the fingers and toes. T Telangiectasia, red spots on the hands, palms, forearms, face and lips. Differential Diagnosis. FAQ Differential diagnosis As shown in Table 2, differential diagnosis is based on the exclusion of diseases showing vascular, skin and visceral changes similar to SSc [2,3]. Physical trauma, chemical exposure, drugs and other autoimmune diseases are accompanied by Raynaud's phenomenon and should be excluded by history, physical an Soft Tissue Calcifications. Soft tissue calcifications pop up all of the time, and it behooves the radiologist to say something intelligent about them. Fortunately the differential diagnosis for this finding is not too difficult. Soft tissue calcifications are usually caused by one of the following six entities Red lesions are a large, heterogeneous group of disorders of the oral mucosa. Traumatic lesions, infections, developmental anomalies, allergic reactions, immunologically mediated diseases, premalignant lesions, malignant neoplasms, and systemic diseases are included in this group. The red color of the lesions may be due to thin epithelium, inflammation, dilatation of blood vessels or increased.

differential diagnoses Calcinosis Cutis (24) Rubeosis Diabeticorum (1) Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasis. If there is no esophageal dysfunction present, the disorder is is known as CRST syndrome. These forms of scleroderma are rare in children Oral lichen planus is a chronic inflammatory disease of unknown etiology or pathogenesis with varied disease severity that waxes and wanes over a long period of time. Although a common oral. Synonyms: Limited scleroderma (see discussion of diffuse scleroderma). ICD-9 Code: 710.1 ICD-10 Code: M34.1 Definition: CREST syndrome is more appropriately referred to as limited scleroderma.In this variant of systemic sclerosis, skin thickening (sclerodactyly) is found distal to the elbow or knee and rarely affects the face or neck

Differential diagnosis of scleroderma (progressive systemic sclerosis) Methodology. Multiplex flow immunoassay Raynaud, esophageal dysfunction, sclerodactyly, telangiectasia). These syndromes are also associated with a high frequency of speckled pattern immunofluorescent antinuclear antibody tests. Scl-70 may identify a subset of. Subepidermal calcified nodule (SCN) of the ocular adnexa is a rare, benign subtype of calcinosis cutis. It typically arises as a painless lesion in young African American or Hispanic males. The nodules are classically described as yellow-white, mobile and firm.[1][2] Complete surgical excision with histopathologic examination is diagnostic as well as curative.[2][3][4 lamina propria. The main differential diagnosis is with Portal Hypertensive Gastropathy, that can frequently co-exists, since about 30% of patients with GAVE co-present a liver cirrhosis. Autoimmune disorders, mainly represented by Reynaud's phenomenon and sclerodactyly, are co-present in about 60% of patient Primary sclerosing cholangitis associated with CREST (calcinosis, Raynaud phenomenon, oesophageal dysmotility, sclerodactyly and telangiectasia) in an elderly woman: a case report. Relevant differential diagnoses for this presentation, which can be difficult to exclude, include immunoglobulin G4-associated cholangitis and antimitochondrial.

Diffuse Systemic Sclerosis. hypo- or hyper- pigmentation of skin, extending from fingers and toes proximally, also involving chest and abdominal wall. Pigment is perserved around hair follicles leading to salt and pepper appearance. Hypopigmentation in Diffuse Scleroderma, courtesy of Regional Derm website sclerodactyly, arthritis, polymyositis, and interstitial lung disease. As in our patient, the skin biopsy was convincing with the diagnosis of scleroderma and also patient did not have any history of joint pain, diagnosis was more in favor of scleroderma. There was no history of occupational exposure to PVE or perchlorethylene Respiratory symptoms can be unspecific, so a simple symptom evaluation may not always help a doctor make a differential diagnosis. 1,6,7 The Symptom Tracker can help your doctor to quickly diagnose any problem. Symptoms 1,6,7 . Feeling out of breath when doing simple tasks like climbing the stairs; Dry cough you can't get rid of; Feeling. The Hereditary Sclerodactyly is a very rare congenital form of Sclerodactyly that already in early childhood with flexion contractures occur. Differential diagnosis. Must be distinguished are systemic sclerosis, camptodactyly and Dupuytren's contracture. therapy

Video: Systemic sclerosis (scleroderma) - Differentials BMJ

Differential diagnosis:Non-genital skin - morphea Genital skin - sexual abuse Early SCC (erythroplasia of Queyrat) - biopsy mandatory Laboratory and Biopsy:Not associated with systemic disease Smudgy collagen in the superficial dermis with flattened DE junctio Hereditary hemorrhagic telangiectasia (HHT or Osler-Weber-Rendu syndrome) is an inherited disorder characterized by malformations of various blood vessels (vascular dysplasia), potentially resulting in bleeding (hemorrhaging) and shunting of blood. Chronic nosebleeds are often the first sign and malformation of various blood vessels may result. Lymphocytic esophagitis is a rare but increasingly recognized cause of chronic esophagitis. The pathogenesis, prognosis, and treatment are undefined. We report the diagnostic workup of an unusual cause of dysphagia. We present a case report of a 71-year-old female who presented with dysphagia for solid foods. The endoscopic appearance showed stenosis at the cricopharyngeus and trachealization.

Scleroderma, Raynaud's Phenomenon, and Related Conditions

Diagnosis. Most patients are positive for ANAs and anti-U1 RNP (see Antibody diagnosis of autoimmune disease ). ANAs have a speckled pattern on immunofluorescence. References: [16] The differential diagnoses listed here are not exhaustive. Treatment. Treatment focuses on organ-specific, symptomatic therapy Differential diagnosis Plaque-related chronic gingivitis, desquamative gingivitis, linear gingiva erythema, trauma, plasma-cell gingivitis, drug reactions, Sclerodactyly, and Telangiectasia. Telangiectasia may occur on the lips and oral mucosa, and presents as red dots or plaques. Treatment Surgical excision, or cryotherapy or laser therapy. Sclerodactyly, calcinosis, telangectasias, hyperpigmentation or hypopigmentation of the skin, loud P2 (indicating pulmonary hypertension), crackles in the lungs (indicating interstitial lung disease) are features consistent with systemic sclerosis. Controversies in the differential diagnosis. It is important to identify underlying. The differential diagnosis includes ecchymosis, vascular lesions, and salivary gland tumors. Definitive diagnosis requires biopsy. Because KS is a multicentric neoplastic disease, multiple sites of involvement can occur, including skin, lymph nodes, gastrointestinal tract, and other organ systems. 119 Differential Diagnosis : History: Lichen myxedematosus is a rare papular infiltrating disorder where mucin is slowly deposited into the dermis, initially as papules but later forming diffuse plaques and nodules and in some cases evolving into the condition known as scleromyxedema with facial changes and sclerodactyly changes similar to scleroderma

The patient's age and sex will influence the likelihood of this being primary or secondary Raynaud's phenomenon. Enquire about any associated symptoms such as migrainous headache, recent joint or muscle pains, rashes, symptoms of infection, weight loss, etc, to detect possible underlying causes Morphea or localized scleroderma is a rare disorder with characteristic clinical features. The treatment of this disease involves the use of long term immunomodulators. Learn more about the clinical features, pathophysiology, laboratory diagnosis, treatment, and the prognosis. Learn more about it in our topic Differential Diagnosis of Buerger Disease. Cardiovascular conditions. Atherosclerosis; Cardiogenic emboli (eg, infective endocarditis) Raynaud phenomenon, esophageal motility, sclerodactyly, and telangiectasias. + + Because of difficulty in accessing medium-sized vessels for biopsy, the diagnosis is rarely confirmed by biopsy. The. On examination, soft whitish-yellow papules and nodules were observed to affect mainly the finger pads and dorsum of the fingers bilaterally ( Figure 1 ). Crusted ulceration was evident on the right index finger. There were no signs of Raynaud's phenomenon, sclerodactyly, arthritis or other skin lesions. Figure 1

Polymyositis Differential Diagnosis. There are numerous health conditions that show signs and symptoms similar to that of Polymyositis, making it difficult to reach a conclusive diagnosis. However, it is important to distinguish Polymyositis from such similar conditions in order to decide on the appropriate treatment methods Acrocyanosis, a benign neurohormonal condition, should be included in the differential diagnosis for Raynaud phenomenon. Raynaud phenomenon is episodic, whereas acrocyanosis leads to persistent cyanosis of the acral body parts (fingers, toes) that is exacerbated by cold temperatures Differential Diagnosis : History: Scleroatrophic syndrome of Huriez is a rare congenital genodermatosis of autosomal dominant inheritance, characterized by scleroatrophy of the hands and feet, nail hypoplasia, palmoplantar keratoderma and hypohidrosis. This 16-year-old boy was born with mild PPK that slowly progressed and worsened alongwith the. The Diagnosis: Fibroblastic Rheumatism palmar thickening, sclerodactyly, and contractures. The eruption may be accompanied by Raynaud phenomenon as well as a progressive symmetric erosive arthropathy Considerations in the differential diagnoses include multicentric reticulohistiocytosis (MRH), palisaded neutrophilic and granulomatous. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Progressive Systemic Sclerosi

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In addition, distal to the wrist, there were sclerodermatous changes involving the skin of the hands with associated sclerodactyly of all digits with loss of normal palmar creases. There were no subungual telangiectasias or digital ulcers. Chanda JJ, Callen JP: Differential diagnosis of sclerodermoid skin changes Differential diagnosis for upper extremity ischemia. For patients with vasculitis, especially small-vessel variants, there may be signs of sclerodactyly and progressive fibrosis of the extremities, trunk, and face. Splinter hemorrhages in the nail bed may be indicative of embolic events Systemic sclerosis (systemic scleroderma) is a chronic condition that occurs in two forms: Diffuse cutaneous systemic sclerosis—the diffuse subset is seen in 10% of systemic scleroderma, often progressing quickly, and is potentially fatal.It can affect large areas of skin, causing thickening and hardening of the skin (sclerosis), abnormal changes with the arteries, joint problems, and. The differential diagnosis for regional osteoporosis is a fairly short and manageable one. The differential diagnosis for generalized osteoporosis is a bit longer and more complex. Generalized Osteoporosis. There are many causes of generalized osteoporosis. minor causalgia, postinfarctional sclerodactyly, shoulder-hand syndrome, and reflex. Differential Diagnosis. (SSc) presents with skin thickening, especially of the hands (sclerodactyly), and often with systemic manifestations as well. SSc patients commonly have Raynaud's phenomenon (RP). RP is a distinctive blanching of white, red and blue/purple discoloration of the digits. These color changes reflect arterial vasospasm.

Differential diagnosis of scleroderma. In the formulation of the diagnosis of systemic scleroderma, the clinical symptomatology of the disease is crucial. The American Rheumatological Association proposed simple diagnostic criteria for systemic scleroderma, including: sclerodactyly; digital ulcers or scars on the palmar surface of the nail. sclerodactyly and telangiectasia) in an elderly woman: a case report differential diagnoses for this presentation, which can be difficult to exclude, include immunoglobulin G4-associated cholangitis and antimitochondrial antibody negative primary biliary cirrhosis. It is of particular significance t The differential diagnosis includes achalasia and diffuse dysmotility. Achalasia is characterized by gastro-esophageal sphincter relaxing failure because of Wallerian degeneration of Auerbach's plexus. The plexus relaxes only when hydrostatic pressure of the column of liquid or food exceeds that of the sphincter (Hurst phenomenon)

Dermatomyositis - American Family Physicia

The case: Three months after an uncomplicated pregnancy and delivery Mrs. D consults her physician about new pain and swelling in her wrists and several proximal interphalangeal joints; 1 wrist is swollen and tender and there is tenderness in the ring metacarpalphalangeal (MCP) and 2 proximal interphalangeal (PIP) joints of each hand. She has morning stiffness which lasts 30 minutes There has. Approach to diagnosis. Etiology: idiopathic, sometimes associated with familial hyperlipidemia; 25-70% of patients have normal lipid levels. Some large-scale studies have documented an association between xanthelasma and risk of cardiovascular disease, regardless of serum cholesterol and other risk factors (Christoffersen, BMJ 2011) Differential Diagnosis. Differential diagnosis includes other systemic connective tissue diseases (Table 17.10-3) and other conditions characterized by positive autoantibodies. Sclerodactyly. Diagnosis of MCTD: Fulfilled serologic criterion and ≥3 of the clinical criteria (coexisting edema of the hands, Raynaud phenomenon, and. Eosinophilic fasciitis can be associated with or progress to morphoea or other autoimmune connective tissue disorders in 20-30% of cases. Associated haematological disorders such as aplastic anaemia and lymphoma have been reported. Spontaneous recovery is reported in 10-20% after 2-5 years. Treatment is typically required for months to years

Diagnostic criteria for connective tissue diseases are often helpful in creating a differential diagnosis in this situation. sclerodactyly, Raynaud's phenomenon, telangiectasias, esophageal. A negative antinuclear antibody test (by indirect immunofluorescence) makes the diagnosis of scleroderma very unlikely. The degree of skin involvement is highly variable. Many patients with limited scleroderma have only subtle cutaneous findings (eg, mild sclerodactyly)

Systemic Sclerosis - Musculoskeletal and Connective Tissue

Differential Diagnosis. Differential diagnoses include rheumatoid arthritis, which can be differentiated by the typical marginal erosions (see Figs. 36.1 and 38.1b), Jaccoud arthropathy of rheumatic fever, which predominantly affect the ulnar side, Sharp syndrome, Ehlers-Danlos syndrome with articular malalignment, subcutaneous fat necroses. Differential diagnosis. Limited systemic sclerosis; Diffuse systemic sclerosis; Mixed connective tissue disease; Morphea (localized scleroderma); tends to be on the trunk, spares hands and fingers On examination, there is microstomia, which is associated with reduced mouth opening. There is sclerodactyly with pulp atrophy, dystrophic nails. Differential diagnosis The differential diagnosis includes chilblains and erythromelalgia. The sclerosis should be distinguished from that of widespread morphoea, porphyria cutanea tarda, mixed connective tissue disease, eosinophilic fasciitis, diabetic sclerodactyly and an acute arthritis with swollen fingers

[Rheography in The Differential Diagnosis Between Raynaud

DIFFERENTIAL DIAGNOSIS. EF may be difficult to differentiate from localized scleroderma, limited and diffuse cutaneous SSc, and several scleroderma-like disorders. RP usually is absent in EF. An overwhelming majority of patients with both limited and diffuse cutaneous forms of SSc have RP or it develops at or near the time of the earliest skin. The differential diagnosis of EM includes peripheral neuropathies, reflex sympathetic dystrophy, nerve compression, plantar neuroma, chronic venous insufficiency, occlusive vascular diseases such as thromboangiitis obliterans, and Fabry's disease and mercury poisoning in children (9,10,15) Abdominal manifestations of von Hippel-Lindau syndrome include renal cysts or tumors, pancreatic cysts or tumors, pheochromocytomas, and papillary epididymal cystadenomas ( Fig 7a - 7d ). Renal cysts occur in 59%-63% of patients, and renal cell carcinoma occurs in 24%-45% of patients ( 46 )

Scleroderma is a rare autoimmune disorder, with a national annual incidence of 20 cases per million in the USA and an estimated prevalence of 150-300 cases per million [1, 2].This complex connective tissue disease is characterized by diverse clinical manifestations and multisystem involvement, with fibrosis of the skin and internal organs [].In his dissertation On Epidemics, Hippocrates. Differential diagnosis: Nodular myositis with rheumatoid arthritis Muscle MRI: Star-shaped hypointense lesions surrounded by increased signal Pathology: Fibrosis surrounded by granulomatous inflammation Sarcoid in muscles may be asymptomatic Granulomas in muscle in 50% to 80% of sarcoid; Serum CK: Usually norma Systemic sclerosis is an autoimmune condition, the aetiology of which is unknown. Many of the clinical and pathologic manifestations result from excessive and often progressive deposition of collagen in the skin and various internal organs Sclerodactyly (skin induration) Differential diagnosis. The diagnosis of scleroderma can sometimes be confused with several other health conditions, including: Eosinophilia Differential Diagnosis. STUDY. Flashcards. Learn. Write. Spell. Test. PLAY. Match. Gravity. Created by. erin_kingham. alternative diagnosis is likely than PE - >3: high pretest prob for DVT 1-2 mod low <0. tests to help diagnose DVT. Sclerodactyly (hardening/shrinking of connective tissue of fingers/toes) lung cancer (bronchogenic.