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A woman with dysphagia and Raynaud's phenomenon
  1. D R Gaya,
  2. R Mactier
  1. Department of Medicine, Glasgow Royal Infirmary, Castle Street, Glasgow G4 0SF, UK
  1. Correspondence to:
 Dr Gaya;
 danielgaya{at}aol.com

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All photographs reproduced with patient's permission. 2002;

Answers on p 109.

A 69 year old woman with no relevant past medical history was admitted with dysphagia. She reported difficulty swallowing both solids and liquids and that it had been gradually worsening over a 10 year period. She denied pain on swallowing and there was no history of regurgitation, heartburn, corrosive ingestion, or weight loss. There was a 25 year history of intermittent attacks of pallor, pain, and redness of the digits.

QUESTIONS

  1. Comment on the appearance of her tongue (fig 1), face (figs 3 and 4), and hands (fig 5).

  2. Comment on the appearance of her barium swallow (fig 2) and suggest a unifying diagnosis.

  3. Examination of her left elbow revealed a hard nodule over the extensor aspect. What does the radiograph (fig 6) show?

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