Why is a paediatric respiratory specialist integral to the paediatric rheumatology clinic?

a) Chest radiograph of child with MCTD. This PA chest radiograph demonstrates retrocardiac left lower lobe consolidation; note increased retrocardiac opacity, indistinct bronchovascular markings and loss of cardiophrenic silhouette. Patent ductus arteriosus occluder device is in situ. b) Chest radiograph of a child with JDM with aspiration pneumonia. There is near total white out of the left hemithorax as a result of dense collapse consolidation of the left lung. There is wedge shaped consolidation in the right mid to lower zone.

Pulmonary function testing in a patient with JSSc showing a restrictive pattern and reduced D_LCO. VC: vital capacity; PEF: peak expiratory flow; FRC: functional residual capacity; TLC: total lung capacity; K_CO: transfer coefficient of the lung for carbon monoxide; V_A: alveolar volume; Hb: haemoglobin. For standardised residuals (SR): a value of >1.64 is the upper limit of normal, <−1.64 is below the lower limit of normal. Severity scale: mild = −1.64 to −2.5; moderate = −2.5 to −3.5; severe= <−3.5.

Chest CT of a teenager with JSSc. a) Axial and b) coronal CT reconstructions: There is widespread intralobular septal thickening, predominating in the subpleural region. The apical segment of the left lower lobe demonstrates honeycombing indicating fibrosis. The fine subpleural ground-glass opacities in the right lower lobe indicates the presence of interstitial inflammation.