Radiological Findings

Based on the provided whole-body and chest-abdominal imaging, the following main features can be observed:

• Muscular Changes: In the limbs and trunk (especially in the proximal large muscle groups), there is a clear reduction in muscle volume, presenting as muscle atrophy and replacement by fat, suggesting fibrosis or progressive degeneration of muscle tissue.
• Skeletal Structure: X-ray images (e.g., ankle joint, shoulder joint) show an overall normal bony contour without obvious fractures or severe bone destruction.
• Chest Changes: On chest CT, certain areas of the lung fields display increased density, which may be related to aspirational lesions or chronic changes; no significant enlargement of mediastinal or hilar lymph nodes or obvious masses are seen.
• Abdominal Condition: There is no notable mass or lymphadenopathy in the digestive tract, and no obvious intestinal distension. The main findings involve muscular and soft tissue changes.

Potential Diagnosis

Combining the patient’s medical history (scleroderma, previous lymphoma) with the above imaging findings, the following diagnostic directions can be considered:

1. Scleroderma-associated myopathy (such as a scleroderma-polymyositis overlap syndrome): The patient has scleroderma and muscle atrophy, and positive anti-PM-Scl antibodies, suggesting a possible overlap syndrome of scleroderma and inflammatory myopathy. Scleroderma leads to widespread fibrosis of connective tissue and muscle fibers, and concomitant myositis can present as proximal muscle atrophy.
2. Lymphoma recurrence or tumor-associated myopathy: Given the patient’s past history of lymphoma, recurrence must be considered; however, this imaging study did not show obvious masses or widespread lymphadenopathy, so the possibility of localized tumor infiltration in the muscles alone is relatively low.
3. Other idiopathic myopathies or chronic wasting diseases: Chronic diseases or systemic inflammation over a long period can lead to generalized muscle atrophy, but correlation with the patient’s specific autoantibodies and scleroderma history requires comprehensive evaluation.

Final Diagnosis

Based on the patient’s disease background (scleroderma and positive anti-PM-Scl antibodies) and the imaging evidence of widespread muscle atrophy and fat replacement, along with clinical symptoms (weight loss, difficulty breathing possibly due to swallowing/esophageal involvement and decreased muscle strength), the most likely diagnosis is myopathic changes in scleroderma overlapping with polymyositis.
If there is still doubt, further tests such as a muscle enzyme panel (CK, AST, LDH, etc.), electromyography, or muscle biopsy can be performed to clarify the degree and nature of the muscle lesion. Excluding lymphoma recurrence or other malignancies is also essential; if necessary, PET-CT or further imaging follow-up can be undertaken.

Treatment Plan and Rehabilitation

For treating scleroderma complicated by myositis, the standard approach generally includes:

• Immunosuppressive Therapy: For active myositis and scleroderma-related lesions, glucocorticoids (e.g., prednisone) or immunomodulators (e.g., methotrexate, cyclophosphamide, mycophenolate mofetil, etc.) are used to regulate the immune response.
• Symptomatic Support: In cases of severe esophageal involvement, swallowing difficulties, or recurrent aspiration pneumonia, specialized evaluation of gastrointestinal function, nutritional support, and prophylactic antibiotics may be required under specialist guidance.
• Physical Therapy and Rehabilitation: Exercise and physiotherapy methods can help maintain and improve muscle strength and joint mobility.

Exercise Rehabilitation/Exercise Prescription (FITT-VP Principle)

When formulating an exercise rehabilitation plan, it is necessary to consider the patient’s cardiopulmonary function and muscle status, following the principles of gradual progression and individualization. A possible reference plan is as follows:

• Frequency: 3–4 times per week is generally suitable, with adjustments based on endurance and muscular capacity.
• Intensity: Begin with low intensity (e.g., 40%–50% of maximum heart rate) to avoid excessive fatigue; gradually increase to moderate intensity according to tolerance.
• Time: Initially, each session may last about 15–20 minutes, including warm-up and cool-down; as tolerance improves, it can be extended to 30 minutes or longer.
• Type: Focus mainly on range-of-motion training, muscle strengthening (resistance bands, light resistance training), and low-impact aerobic exercise (e.g., walking on flat ground, cycling on a stationary bike), avoiding high-load training.
• Progression: After symptom control and improvement in muscle strength, slightly increase resistance or lengthen aerobic exercise duration every 2–4 weeks; closely monitor fatigue and joint pain.
• Volume and Pattern: Exercises can be done in segments, for example, 10 minutes each time, split into 2–3 sessions to reduce fatigue risk; for strength training, start with 1–2 sets of small weights and multiple repetitions, then increase sets as appropriate.

Disclaimer

This report provides a reference analysis based on the existing imaging and clinical history and cannot substitute for face-to-face consultation or professional medical advice. Specific diagnoses and treatment plans should be made by a specialist physician using clinical examinations, further imaging, and laboratory results for a comprehensive evaluation.