Joint Bone Spine 80 (2013) 102–103
Available online at
Images in rheumatology
Continuous diaphragm sign in amyopathic dermatomyositis
, Darshan S. Bhakuni , Krishnan Shanmuganandan
Department of Rheumatology, Army Hospital (Research & Referral), New Delhi 110010, India
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 dys-
phonia. 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. How-
ever, he did not have clinical or laboratory evidence of myositis.
X-ray chest PA view (Fig. 1) showed features of pneumomedi-
astinum in the form of “continuous diaphragm sign” (arrow) with
air tracking over fascial planes (asterisk) in the neck. High resolu-
tion computerised tomography (HRCT) of the chest conﬁrmed the
pneumomediastinum and also revealed evidence of early intersti-
tial lung disease. Patient was managed with supplemental oxygen
Corresponding author. Tel.: +912 3338 167.
E-mail address: firstname.lastname@example.org (S. Kartik).
1297-319X/$ – see front matter © 2012 Société franc¸ aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.