The value of ultrasound in the diagnosis of limited scleroderma – a case report

Systemic sclerosis, popularly referred to as scleroderma, is a chronic connective tissue disease with present autoantibodies against platelet-derived growth factor receptor. These antibodies activate directly fi broblasts causing the dermis and internal organs' fi brosis and vascular damage. Additionally, calcifi c collections, including hydroxyapatite crystals, may develop in subcutaneous tissue and juxta-articular soft tissue. Herein, we report a case of a 72-year-old woman, referred by a rheumatologist for plain radiography and ultrasound examination of hands due to pain and swelling of the fourth fi nger of the left hand. Dermal induration affecting hands, especially fourth fi nger on the left side and the Raynaud phenomenon were observed on physical examination. Furthermore, the patient had noticed periodic discharge with a toothpaste consistency from a tiny fi stula localised in the vicinity of the fourth fi nger alterations. The paper emphasises a possible application of the twinkling artefact and MicroPure option on ultrasound examination in differential diagnosis of soft tissue calcifi cations. Making the correct diagnosis can attribute to precise planning of surgical treatment.