History
A 61-year-old housewife first noted symptoms of Raynaud phenomenon and cutaneous scleroderma in 1963. Progressive dyspnea with pulmonary fibrosis and rightsided cardiac failure began in 1969. Since 1973, she has had intermittent episodes of cramping abdominal pain with nausea along with dyspnea, cough, and loss of weight. In November 1974, the patient was hospitalized because of progressive abdominal pain and vomiting. Physical examination demonstrated advanced skin changes of scleroderma, signs of pulmonary hypertension, and cardiac failure. The abdomen was distended but soft and nontender. Bowel sounds were normal. Results of laboratory studies were normal except for findings indicative of moderate malabsorption. Figures 1 through 3 were obtained on this admission.
Diagnosis
Scleroderma of the skin, lung, esophagus, and the small bowel, complicated by pneumatosis cystoides intestinalis and pneumoperitoneum.
Comment
The chest roentgenogram (Fig 1) shows diffuse pulmonary fibrosis and cor pulmonale as well as congestive heart failure. Free air