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Pulmonary Hypertension in the CREST Syndrome Variant of Progressive Systemic Sclerosis (Scleroderma)

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Grant support: in part by Grant 5 TO1 HL 05678-10 from the National Heart and Lung Institute, the RGK Foundation and the U.S. Public Health Service Grant FR-00056 from the National Institutes of Health.

Presented in part at the 46th Session of the American Heart Association, 8 through 11 November, Atlantic City, New Jersey.

▸Requests for reprints should be addressed to Rosemarie Salerni, M.D.; 789 Scaife Hall, University of Pittsburgh School of Medicine; Pittsburgh, PA 15261.

Pittsburgh, Pennsylvania

Ann Intern Med. 1977;86(4):394-399. doi:10.7326/0003-4819-86-4-394
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Severe pulmonary hypertension without pulmonary fibrosis occurred in 10 patients with the CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia), reputedly a benign variant of progressive systemic sclerosis. Time from the initial symptom, Raynaud's phenomenon, to the recognition of pulmonary hypertension was as long as 40 years. Pulmonary hypertension and increased pulmonary vascular resistance was shown in all patients. Autopsy examination in three of six deaths attributable to pulmonary hypertension showed intimal proliferation with myxomatous change in the small- and medium-sized pulmonary arteries similar to changes in the digital arteries of patients with scleroderma and Raynaud's phenomenon, and interlobular renal arteries of those with "scleroderma kidney." It is concluded that the CREST syndrome is not entirely benign but may be complicated, after a long clinical course, by progressive pulmonary vascular obliteration, pulmonary hypertension, and death in the absence of significant pulmonary fibrosis.





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