Images in Clinical Medicine

Mediastinal Abnormalities in Systemic Sclerosis

William Choe, M.D., and David Mehlman, M.D.

N Engl J Med 2000; 343:1771December 14, 2000

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Figure 1 A 37-year-old woman who had had systemic sclerosis for several years, with known esophageal and skin involvement, presented with dyspnea on exertion and a large pericardial effusion. Transthoracic echocardiography was performed, with parasternal long-axis views obtained before (Panel A) and after (Panel B) pericardiocentesis. The following mediastinal abnormalities are evident: right ventricular hypertrophy due to pulmonary hypertension, left ventricular hypertrophy related to systemic hypertension, a pericardial effusion (PE), and a fluid-filled, dilated esophagus (E) due to esophageal dysmotility. Right ventricular hypertrophy is defined echocardiographically as a right ventricular diastolic free-wall thickness in excess of 5 mm. Normally, the esophagus is not seen on a transthoracic echocardiogram. In this case, however, the echocardiogram clearly shows the proximity of the esophagus and the left atrium (LA), a relation on which transesophageal echocardiography depends. RV denotes right ventricle, LV left ventricle, PW the posterior wall of the left ventricle, and Ao aorta.

William Choe, M.D.
David Mehlman, M.D.
Northwestern Memorial Hospital, Chicago, IL 60611