Yamakawa H, et al. - Researchers here describe a new finding characterized by peculiar emphysematous change with systemic sclerosis (SSc)-associated interstitial lung disease (ILD) [(SSc-ILD)]. The identified pulmonary emphysematous changes [low attenuation area (LAA) within interstitial abnormalities on high-resolution computed tomography (HRCT) and destruction of fibrously thickened alveolar walls)] represented specific and novel radio-pathological features of SSc-ILD. Notably, via facilitating destruction in the fibrously thickened alveolar walls, peripheral vasculopathy may result in emphysematous change in SSc-ILD.