Radiological thymus alterations in systemic sclerosis: our experience and a review of the literature

Thymus alterations have been related to several autoimmune disorders. In particular, previous studies identified a significant frequency of gland abnormalities by chest high-resolution CT (HRCT) in SSc patients. In this study we aimed to investigate the prevalence of radiological thymic alterations...

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Published in:Rheumatology (Oxford, England) England), 2014-04, Vol.53 (4), p.732-736
Main Authors: Colaci, Michele, Giuggioli, Dilia, Manfredi, Andreina, Vacchi, Caterina, Della Casa, Giovanni, Ferri, Clodoveo
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Autoantibodies - immunology
Female
Humans
Male
Middle Aged
Retrospective Studies
Scleroderma, Systemic - complications
Scleroderma, Systemic - diagnostic imaging
Scleroderma, Systemic - immunology
Thymus Gland - diagnostic imaging
Thymus Hyperplasia - complications
Thymus Hyperplasia - diagnostic imaging
Tomography, X-Ray Computed
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Summary:Thymus alterations have been related to several autoimmune disorders. In particular, previous studies identified a significant frequency of gland abnormalities by chest high-resolution CT (HRCT) in SSc patients. In this study we aimed to investigate the prevalence of radiological thymic alterations and their correlation with clinical and serological features in a large SSc series. We retrospectively evaluated thymic shape on CT scans of 200 consecutive, unselected SSc patients aged over 30 years The presence of radiological abnormalities, i.e. enlarged gland >13 mm or nodular lesions >7 mm, was correlated with SSc clinico-serological features. Moreover, the patients were also classified using a second thickness cut-off of 7 mm in order to identify incomplete thymic involution. Twenty-four of 200 (12%) SSc patients presented an abnormal thymus at HRCT, including hyperplasic (19/24) and nodular (5/24) glands. Otherwise, using the cut-off of 7 mm for gland thickness and excluding subjects with nodular thymus, 50/195 (25.6%) patients presented an incomplete thymic involution. Thymic radiological alterations are significantly correlated with younger age and diffuse cutaneous SSc. Moreover, an abnormally enlarged thymus tended to be more common in patients with shorter disease duration. The present report on a large series of SSc patients further reinforces previous data present in the literature that includes other cohort studies and a number of anecdotal observations. Even though the actual role of thymus radiological abnormalities remains unclear, possible involvement of the gland in the early phase of immune-mediated SSc pathogenesis might be supposed.
ISSN:1462-0324
1462-0332
DOI:10.1093/rheumatology/ket419