At recruitment we heard a case of a 53 year old female with progressive shortness of breath, worsening LE edema and history of other vague symptoms including upper extremity swelling, Raynaud’s and dysphagia with pills. Her exam was significant for tightening of the skin, a harsh systolic murmur and edema and ECHO showed severe pulmonary HTN. After appropriate work up she was found to have diffuse cutaneous systemic sclerosis and unfortunately her pulmonary disease progressed and she ultimately did not survive. Below you can find teaching points on pulmonary HTN as well as scleroderma: