Systemic lupus erythematosus ultrasound or echocardiography

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

On abdominal ultrasound, systemic lupus erythematosus (SLE) may present with hepatosplenomegaly, ascites, hyperecho-kidney tissue due to nephritis, and rarely cholecystitis. On synovial ultrasound, SLE may present with synovial effusions and synovitis. On echocardiography, SLE may present with decreased ejection fraction, cardiac wall motion abnormality, effusion pericarditis, and valve leaflet thickening.

Ultrasound

Ultrasound can be used for the diagnosis of systemic lupus erythematosus complications. It can also be used for screening and monitoring the disease activity during pregnancy. The table below presents the main ultrasound findings regarding the organ system involvement in SLE:

Organ	Sonography findings	Preview
Gastrointestinal	General Free fluid in the abdomen suggestive of ascites Liver Hepatomegaly Hepatic steatosis Pancreas Hypoechoic necrosis regions May accompany vascular complications, e.g. thrombosis Spleen Splenomegaly In cases of autosplenectomy, ultrasound will either not be able to demonstrate a spleen at all, or identify a small irregular and shadowing nodule in the splenic bed Cholecystitis Gallbladder wall thickening (>3 mm) and pericholecystic fluid Positive murphy sign Gallbladder distension	Adapted from Radiopaedia Adapted from Radiopaedia
Renal	Generally hyperechoic kidneys Loss of corticomedullary differentiation The size of the kidneys vary depending on the duration of the involvement Small and diffusely echogenic kidneys mostly on SLE-related chronic renal failure
Pulmonary	Pleural effusion Echo-free space between the visceral and parietal pleura	Adapted from Radiopaedia
Joints	Synovial proliferation Synovial effusions and subclinical synovitis Usually no erosions (the difference between SLE and RA) Tenosynovitis Global thickening with effusion in the sheath of tendon	Adapted from Radiopaedia
Raynaud phenomenon	Doppler sonography In the presence of Raynaud phenomenon, may show flow volume and vessel size irregularities

Echocardiography

Main echocardiographic findings in SLE include: Decreased ejection fraction Myocarditis Wall motion abnormality diagnosed mostly by trans-esophageal echocardiography Valvular abnormalities Valve leaflet thickening due to Libman-Sacks endocarditis characterized by the formation of small single or multiple, sterile, granular pink vegetations ranging from 1 to 4 mm Valve thickening Valve regurgitation Pericardial effusion Echocardiography is the method of choice to confirm the diagnosis, estimate the volume of fluid and most importantly assess the haemodynamic impact of the effusion

Adapted from Radiopaedia