CTICasesScleroderma ILD with Lymphadenopathy and Progressive Mediastinal Lymph Node Calcification
Imaging findings
CT in a retired bricklayer with scleroderma demonstrates rapidly progressive basal-predominant NSIP-pattern lung fibrosis with bilateral lower lobe traction bronchiectasis, dilated esophagus, progressive mediastinal lymphadenopathy, and developing eggshell-like calcification in mediastinal lymph nodes on serial imaging.
Key takeaways
Scleroderma is a well-recognized cause of mediastinal and hilar lymphadenopathy that can be distractingly pronounced. Progressive dystrophic calcification of these lymph nodes, while uncommon, may be a manifestation of the underlying autoimmune disease. The concurrent history of silica exposure complicates the differential, but scleroderma itself is sufficient to explain the lymph node enlargement. Eggshell calcification is classically associated with silicosis and sarcoidosis but has been described in other contexts.
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