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Continuous diaphragm sign in amyopathic dermatomyositis

A 35-year-old male presented with symmetric inflammatory polyarthritis, malar rash, photosensitivity, Raynaud's phenomenon, weight loss and recent onset breathlessness on exertion and dysphonia. Clinical evaluation revealed heliotrope rash over malar and periorbital regions, Gottron's papules and punched out ulcers over elbows and knuckles. He also had subcutaneous emphysema. However, he did not have clinical or laboratory evidence of myositis. X-ray chest PA view ( Fig. 1 ) showed features of pneumomediastinum in the form of “continuous diaphragm sign” (arrow) with air tracking over fascial planes (asterisk) in the neck. High resolution computerised tomography (HRCT) of the chest confirmed the pneumomediastinum and also revealed evidence of early interstitial lung disease. Patient was managed with supplemental oxygen and exhibited prednisolone (1 mg/kg body weight) with which he showed resolution of pneumomediastinum and skin lesions.</P>Pneumomediastinum is an uncommon manifestation of dermatomyositis. However it is more commonly seen in seen amyopathic dermatomyositis with rapidly progressive interstitial lung disease [1] . Continuous diaphragm sign occurs as a result of interposition of gas between heart and diaphragm that permits the visualization of central portion of diaphragm in continuity with the lateral portions [2] as illustrated ( Fig. 2 a ) in contrast to normal http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Joint Bone Spine Elsevier
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