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Pulmonary and Critical Care Pearls |

A 69-Year-Old Woman With CREST Syndrome, Dyspnea, and a Mosaic CT Attenuation Pattern*

Ritu Madan, DO; Thomas J. Donnelly, MD
Author and Funding Information

*From the Miami Valley Hospital, Medical Education Department, One Wyoming St, Dayton, OH 45409.

Correspondence to: Ritu Madan, DO, Miami Valley Hospital, Medical Education Department, One Wyoming St, Dayton, OH 45409



Chest. 2000;117(2):584-587. doi:10.1378/chest.117.2.584
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A 69 -year-old nonsmoking woman with a history of CREST (calcinosis, Reynaud’s phenomenon, esophageal motility disorders, sclerodactyly, and telangiectasia) syndrome presented with a chief complaint of dyspnea. The patient first noticed telangiectasias on her hands and face 20 years earlier and slowly developed tightness of the skin on her hands and face. Five years before admission, she was evaluated for symptoms of gastroesophageal reflux disease (GERD) and was found to have an esophageal stricture. Her symptoms responded well to stricture dilation and treatment with omeprazole and cisapride. She had no history or symptoms suggestive of aspiration. Serologic testing at that time showed an antinuclear antibody titer of > 1:640 with a centromere pattern, negative Scl-70 antibodies, rheumatoid factor of 143 IU/mL, and erythrocyte sedimentation rate of 15 mm/h. The patient did well until 6 months prior to admission when she noticed dyspnea on exertion. She was evaluated by her primary care physician and was referred for further evaluation.

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