Systemic lupus erythematosus x ray: Difference between revisions

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__NOTOC__
__NOTOC__
{{Systemic lupus erythematosus}}
{{Systemic lupus erythematosus}}
{{CMG}}
{{CMG}} {{AE}} {{MIR}}


==Overview==
==Overview==
On X ray imaging, systemic lupus erythematosus (SLE) may be characterized by different features regarding the present complication. the most common characteristic findings of SLE in X ray include: [[Thumbprinting|thumb printing sign]] in the abdominal graphy, blunting of the [[costophrenic angle]] due to [[pleural effusion]], [[cardiomegaly]], and bone deformity.  
On X-ray imaging, systemic lupus erythematosus (SLE) may be characterized by different features regarding the present complication. The most common characteristic findings of SLE in X-ray include [[Thumbprinting|thumb printing sign]] in the abdominal X ray, blunting of the [[costophrenic angle]] due to [[pleural effusion]], [[cardiomegaly]], [[hepatomegaly]], [[Osteoporosis|osteoprosis]], tenosinovitis, and other manifestations based on the complications.  


==X Ray==
==X Ray==
On X ray imaging, systemic lupus erythematosus (SLE) may be characterized by the following features, based on the organ system involvement.<ref name="pmid23812167">{{cite journal |vauthors=Appenzeller S |title=Magnetic resonance imaging in systemic lupus erythematosus: where do we stand? |journal=Cogn Behav Neurol |volume=26 |issue=2 |pages=53–4 |year=2013 |pmid=23812167 |doi=10.1097/WNN.0b013e31829d5b60 |url=}}</ref><ref name="pmid26309728">{{cite journal |vauthors=Thurman JM, Serkova NJ |title=Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus |journal=F1000Res |volume=4 |issue= |pages=153 |year=2015 |pmid=26309728 |pmc=4536614 |doi=10.12688/f1000research.6587.2 |url=}}</ref><ref name="pmid26038342">{{cite journal |vauthors=Lin K, Lloyd-Jones DM, Li D, Liu Y, Yang J, Markl M, Carr JC |title=Imaging of cardiovascular complications in patients with systemic lupus erythematosus |journal=Lupus |volume=24 |issue=11 |pages=1126–34 |year=2015 |pmid=26038342 |pmc=4567427 |doi=10.1177/0961203315588577 |url=}}</ref><ref name="pmid26236469">{{cite journal |vauthors=Sarbu N, Bargalló N, Cervera R |title=Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus |journal=F1000Res |volume=4 |issue= |pages=162 |year=2015 |pmid=26236469 |pmc=4505788 |doi=10.12688/f1000research.6522.2 |url=}}</ref><ref name="pmid24696368">{{cite journal |vauthors=Qin H, Guo Q, Shen N, Huang X, Wu H, Zhang M, Bao C, Chen S |title=Chest imaging manifestations in lupus nephritis |journal=Clin. Rheumatol. |volume=33 |issue=6 |pages=817–23 |year=2014 |pmid=24696368 |doi=10.1007/s10067-014-2586-2 |url=}}</ref><ref name="pmid22901453">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part II: gastrointestinal, renal, and musculoskeletal manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=192–202 |year=2013 |pmid=22901453 |doi=10.1016/j.crad.2012.06.109 |url=}}</ref><ref name="pmid23943987">{{cite journal |vauthors=Gal Y, Twig G, Mozes O, Greenberg G, Hoffmann C, Shoenfeld Y |title=Central nervous system involvement in systemic lupus erythematosus: an imaging challenge |journal=Isr. Med. Assoc. J. |volume=15 |issue=7 |pages=382–6 |year=2013 |pmid=23943987 |doi= |url=}}</ref><ref name="pmid1448334">{{cite journal |vauthors=Shirato M, Hisa N, Fujikura Y, Ohkuma K, Kutsuki S, Hiramatsu K |title=[Imaging diagnosis of lupus enteritis--especially about sonographic findings] |language=Japanese |journal=Nihon Igaku Hoshasen Gakkai Zasshi |volume=52 |issue=10 |pages=1394–9 |year=1992 |pmid=1448334 |doi= |url=}}</ref><ref name="pmid25275093">{{cite journal |vauthors=Adachi JD, Lau A |title=Systemic lupus erythematosus, osteoporosis, and fractures |journal=J. Rheumatol. |volume=41 |issue=10 |pages=1913–5 |year=2014 |pmid=25275093 |doi=10.3899/jrheum.140919 |url=}}</ref><ref name="pmid21718325">{{cite journal |vauthors=Curiel R, Akin EA, Beaulieu G, DePalma L, Hashefi M |title=PET/CT imaging in systemic lupus erythematosus |journal=Ann. N. Y. Acad. Sci. |volume=1228 |issue= |pages=71–80 |year=2011 |pmid=21718325 |doi=10.1111/j.1749-6632.2011.06076.x |url=}}</ref><ref name="pmid22901452">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part I: CNS, cardiovascular, and thoracic manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=181–91 |year=2013 |pmid=22901452 |doi=10.1016/j.crad.2012.06.110 |url=}}</ref><ref name="pmid11571369">{{cite journal |vauthors=Rockall AG, Rickards D, Shaw PJ |title=Imaging of the pulmonary manifestations of systemic disease |journal=Postgrad Med J |volume=77 |issue=912 |pages=621–38 |year=2001 |pmid=11571369 |pmc=1742125 |doi= |url=}}</ref>
Findings on an X ray imaging for systemic lupus erythematosus (SLE) depends on the organ system involvement and may include the following features.<ref name="pmid23812167">{{cite journal |vauthors=Appenzeller S |title=Magnetic resonance imaging in systemic lupus erythematosus: where do we stand? |journal=Cogn Behav Neurol |volume=26 |issue=2 |pages=53–4 |year=2013 |pmid=23812167 |doi=10.1097/WNN.0b013e31829d5b60 |url=}}</ref><ref name="pmid26309728">{{cite journal |vauthors=Thurman JM, Serkova NJ |title=Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus |journal=F1000Res |volume=4 |issue= |pages=153 |year=2015 |pmid=26309728 |pmc=4536614 |doi=10.12688/f1000research.6587.2 |url=}}</ref><ref name="pmid26038342">{{cite journal |vauthors=Lin K, Lloyd-Jones DM, Li D, Liu Y, Yang J, Markl M, Carr JC |title=Imaging of cardiovascular complications in patients with systemic lupus erythematosus |journal=Lupus |volume=24 |issue=11 |pages=1126–34 |year=2015 |pmid=26038342 |pmc=4567427 |doi=10.1177/0961203315588577 |url=}}</ref><ref name="pmid26236469">{{cite journal |vauthors=Sarbu N, Bargalló N, Cervera R |title=Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus |journal=F1000Res |volume=4 |issue= |pages=162 |year=2015 |pmid=26236469 |pmc=4505788 |doi=10.12688/f1000research.6522.2 |url=}}</ref><ref name="pmid24696368">{{cite journal |vauthors=Qin H, Guo Q, Shen N, Huang X, Wu H, Zhang M, Bao C, Chen S |title=Chest imaging manifestations in lupus nephritis |journal=Clin. Rheumatol. |volume=33 |issue=6 |pages=817–23 |year=2014 |pmid=24696368 |doi=10.1007/s10067-014-2586-2 |url=}}</ref><ref name="pmid22901453">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part II: gastrointestinal, renal, and musculoskeletal manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=192–202 |year=2013 |pmid=22901453 |doi=10.1016/j.crad.2012.06.109 |url=}}</ref><ref name="pmid23943987">{{cite journal |vauthors=Gal Y, Twig G, Mozes O, Greenberg G, Hoffmann C, Shoenfeld Y |title=Central nervous system involvement in systemic lupus erythematosus: an imaging challenge |journal=Isr. Med. Assoc. J. |volume=15 |issue=7 |pages=382–6 |year=2013 |pmid=23943987 |doi= |url=}}</ref><ref name="pmid1448334">{{cite journal |vauthors=Shirato M, Hisa N, Fujikura Y, Ohkuma K, Kutsuki S, Hiramatsu K |title=[Imaging diagnosis of lupus enteritis--especially about sonographic findings] |language=Japanese |journal=Nihon Igaku Hoshasen Gakkai Zasshi |volume=52 |issue=10 |pages=1394–9 |year=1992 |pmid=1448334 |doi= |url=}}</ref><ref name="pmid25275093">{{cite journal |vauthors=Adachi JD, Lau A |title=Systemic lupus erythematosus, osteoporosis, and fractures |journal=J. Rheumatol. |volume=41 |issue=10 |pages=1913–5 |year=2014 |pmid=25275093 |doi=10.3899/jrheum.140919 |url=}}</ref><ref name="pmid21718325">{{cite journal |vauthors=Curiel R, Akin EA, Beaulieu G, DePalma L, Hashefi M |title=PET/CT imaging in systemic lupus erythematosus |journal=Ann. N. Y. Acad. Sci. |volume=1228 |issue= |pages=71–80 |year=2011 |pmid=21718325 |doi=10.1111/j.1749-6632.2011.06076.x |url=}}</ref><ref name="pmid22901452">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part I: CNS, cardiovascular, and thoracic manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=181–91 |year=2013 |pmid=22901452 |doi=10.1016/j.crad.2012.06.110 |url=}}</ref><ref name="pmid11571369">{{cite journal |vauthors=Rockall AG, Rickards D, Shaw PJ |title=Imaging of the pulmonary manifestations of systemic disease |journal=Postgrad Med J |volume=77 |issue=912 |pages=621–38 |year=2001 |pmid=11571369 |pmc=1742125 |doi= |url=}}</ref>


=== More common complications ===
=== More common findings ===
{| class="wikitable"
{| class="wikitable"
! style="background: #4479BA; color: #FFFFFF; " |Organ
! style="background: #4479BA; color: #FFFFFF; " |Organ
! style="background: #4479BA; color: #FFFFFF; " |Disease
! style="background: #4479BA; color: #FFFFFF; " |Disease
! style="background: #4479BA; color: #FFFFFF; " |Description
! style="background: #4479BA; color: #FFFFFF; " |Description
! style="background: #4479BA; color: #FFFFFF; " |Preview
|-
|-
| style="background: #DCDCDC; " |[[Gastrointestinal system]]
| style="background: #DCDCDC; " |<small><small>[[Gastrointestinal system]]</small></small>
![[Enteritis]]
![[Enteritis]]
|
|
* [[Small bowel]] wall thickening
* [[Small bowel]] wall thickening
** [[Thumbprinting|Thumbprinting sign]]
** [[Thumbprinting|Thumbprinting sign]]
|
[[File:Thumbpronting.gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
| rowspan="3" style="background: #DCDCDC; " |[[Pulmonary|Pulmonary involvement]]
| rowspan="4" style="background: #DCDCDC; " |<small><small>[[Pulmonary|Pulmonary involvement]]</small></small>
![[Pleural effusion]]
![[Pleural effusion]]
|
|
* Lateral decubitus graphy:
* Lateral decubitus view:
** Can visualise small amounts of fluid layering against the dependent [[parietal pleura]]
** Visible small amounts of fluid layering against the dependent [[parietal pleura]]
* PA and AP CXR:
* PA and AP CXR:
** Blunting of the [[costophrenic angle]]
** Blunting of the [[costophrenic angle]]
Line 31: Line 34:
** Fluid within the [[Horizontal fissure of right lung|horizontal]] or [[Oblique fissure|oblique fissures]]
** Fluid within the [[Horizontal fissure of right lung|horizontal]] or [[Oblique fissure|oblique fissures]]
** [[Mediastinal]] shifts with large amounts of fluid
** [[Mediastinal]] shifts with large amounts of fluid
|
[[File:Pleural effusion.gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
![[Pulmonary fibrosis]]
|
* Diffuse increased interstitial markings
* Reduce in lung volume
* [[Pulmonary nodule|Pulmonary nodularity]] may be seen
* Shaggy outline to the heart
** Due to adjacenet [[Pulmonary Fibrosis|lung fibrosis]] so the outline of the heart is less well delineated
* Tracheomegaly
|
[[File:Pulmonary fibrosis.gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
![[Pulmonary hypertension]]
![[Pulmonary hypertension]]
Line 38: Line 54:
* Prominent pulmonary outflow tract
* Prominent pulmonary outflow tract
* Enlarged [[pulmonary arteries]]
* Enlarged [[pulmonary arteries]]
|
[[File:PHTN.gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
![[Pneumonitis|Acute pneumonitis]]
![[Pneumonitis|Acute pneumonitis]]
|
|
*[[Bilateral]] patchy airspace opacification
*[[Bilateral]] patchy airspace opacification
|
[[File:Webp.net-gifmaker (2).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
| rowspan="2" style="background: #DCDCDC; " |[[Cardiac|Cardiac involvement]]
| rowspan="2" style="background: #DCDCDC; " |<small><small>[[Cardiac|Cardiac involvement]]</small></small>
![[Cardiomegaly]]
![[Cardiomegaly]]
|
|
*[[Cardiac enlargement]]
*[[Cardiac enlargement]]
| rowspan="2" |
[[File:270780927951f0155ba941fe2264d1 big gallery.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
![[Mitral stenosis]]
![[Mitral stenosis]]
|
|
*[[Cardiomegaly]] with [[Widened mediastinum|widening the heart shadow]]
*[[Cardiomegaly]]
*Double right heart border (enlarged [[left atrium]] and normal [[right atrium]])
*Double right heart border (enlarged [[left atrium]] and normal [[right atrium]])
*Prominent [[left atrial]] appendage
*Prominent [[left atrial]] appendage
*Splaying of the subcarinal angle (>120 degrees)
*Splaying of the subcarinal angle (>120 degrees)
|-
|-
| rowspan="2" style="background: #DCDCDC; " |[[Musculoskeletal system|Musculoskeletal]] involvement
| rowspan="2" style="background: #DCDCDC; " |<small><small>[[Musculoskeletal system|Musculoskeletal]] involvement</small></small>
![[Arthritis]]
![[Arthritis]]
|
|
Line 67: Line 89:
*Widened forefoot
*Widened forefoot
*[[Hallux valgus]]
*[[Hallux valgus]]
|
[[File:Webp.net-gifmaker (3).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
![[Osteoporosis]]
![[Osteoporosis]]
Line 74: Line 98:
**[[Periosteal reaction]] progressing to callus formation in diaphyseal fractures
**[[Periosteal reaction]] progressing to callus formation in diaphyseal fractures
**Linear [[sclerosis]] and cortical thickening more frequent in [[metaphyseal]] and [[epiphyseal]] [[fractures]]
**Linear [[sclerosis]] and cortical thickening more frequent in [[metaphyseal]] and [[epiphyseal]] [[fractures]]
*Decrease
|
[[File:Webp.net-gifmaker (4).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|}
|}


=== Less common complications ===
=== Less common findings ===
{| class="wikitable"
{| class="wikitable"
! style="background: #4479BA; color: #FFFFFF; " |Organ
! style="background: #4479BA; color: #FFFFFF; " |Organ
! style="background: #4479BA; color: #FFFFFF; " |Disease
! style="background: #4479BA; color: #FFFFFF; " |Disease
! style="background: #4479BA; color: #FFFFFF; " |Description
! style="background: #4479BA; color: #FFFFFF; " |Description
! style="background: #4479BA; color: #FFFFFF; " |Preview
|-
|-
| rowspan="2" style="background: #DCDCDC; " |[[Gastrointestinal]] system
| rowspan="3" style="background: #DCDCDC; " |<small><small>[[Gastrointestinal]] system</small></small>
![[Intestinal pseudo-obstruction]]
![[Intestinal pseudo-obstruction]]
|
|
*Dilated [[bowel]] loops with or without the presence of fluid levels
*Dilated [[bowel]] loops with or without the presence of fluid levels
*Erect [[chest]] radiographs for [[perforation]] evaluating
*Upright [[chest]] radiographs for [[perforation]] evaluating
|
[[File:Webp.net-gifmaker (5).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
![[Autosplenectomy]]
![[Autosplenectomy]]
|
|
* Calcified [[spleen]] may be visible in the left upper quadrant
* Calcified [[spleen]] may be visible in the left upper quadrant
|
|-
|-
| rowspan="4" style="background: #DCDCDC; " |[[Pulmonary]] involvement
![[Hepatomegaly]]
|
* Enlargement of liver silhouette
* Medially displaced bowel loops
|
[[File:Webp.net-gifmaker (6).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
| rowspan="4" style="background: #DCDCDC; " |<small><small>[[Pulmonary]] involvement</small></small>
![[Respiratory failure|Respiratory muscle dysfunction]]
![[Respiratory failure|Respiratory muscle dysfunction]]
|
|
*Elevated hemidiaphragms at [[CXR]]
*Elevated hemidiaphragms at [[CXR]]
*Linear [[atelectasis]] and an ill-defined juxtadiaphragmatic areas of increased opacity
*Linear [[atelectasis]] and an ill-defined juxtadiaphragmatic areas of increased opacity
|
[[File:Webp.net-gifmaker (7).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
![[Pulmonary hemorrhage]]
![[Pulmonary hemorrhage]]
|
|
*Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
*Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
|
[[File:Webp.net-gifmaker (8).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
![[Pulmonary emboli]]
![[Pulmonary emboli]]
|
|
*[[Fleischner sign|Fleishner sign]]: Enlarged [[pulmonary artery]]
*[[Fleischner sign|Fleishner sign]]: Enlarged [[pulmonary artery]]
*[[Hampton's hump|Hampton hump]]: Peripheral wedge of airspace opacity and implies [[lung infarction]]
*[[Hampton's hump|Hampton hump]]: Peripheral wedge of airspace opacity and implied [[lung infarction]]
*[[Westermark sign]]: Regional oligoemia
*[[Westermark sign]]: Regional oligoemia
*[[Pleural effusion]]
*[[Pleural effusion]]
|
[[File:Webp.net-gifmaker (9).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
!Shrinking lung syndrome
!Shrinking lung syndrome
Line 113: Line 157:
*Small but clear [[lungs]] with [[diaphragmatic elevation]]
*Small but clear [[lungs]] with [[diaphragmatic elevation]]
*Basal [[atelectasis]] 
*Basal [[atelectasis]] 
|
|-
|-
| rowspan="2" style="background: #DCDCDC; " |[[Cardiac]] involvement
| rowspan="2" style="background: #DCDCDC; " |<small><small>[[Cardiac]] involvement</small></small>
![[Mitral regurgitation]]
![[Mitral regurgitation]]
|
|
*[[Left atrial enlargement]]
*[[Left atrial enlargement]]
**Convexity or straightening of the [[left atrial appendage]] just below the main [[pulmonary artery]] (along left heart border)
**Convexity or straightening of the [[left atrial appendage]] just below the main [[pulmonary artery]] (along with left heart border)
**Double density sign: An addition contour superimposed over the [[right heart]] due to [[Left atrial enlargement|left atrium enlargement]]
**Double density sign: An addition contour superimposed over the [[right heart]] due to [[Left atrial enlargement|left atrium enlargement]]
**Elevation of the left main [[bronchus]] and splaying of the [[carina]]
**Elevation of the left main [[bronchus]] and splaying of the [[carina]]
*Upper zone venous enlargement due to [[pulmonary hypertension]]
*Upper zone venous enlargement due to [[pulmonary hypertension]]
*Left [[ventricular]] enlargement is also eventually present due to volume overload
*Left [[ventricular]] enlargement is also eventually present due to volume overload
|
[[File:Webp.net-gifmaker (10).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
![[Pericardial effusion]]
![[Pericardial effusion]]
|
|
*Globular enlargement of the cardiac shadow giving a water bottle configuration
*Globular enlargement of the cardiac shadow giving a water bottle configuration
*Anteroposterior [[CXR]]:
**Enlarged cardiac silhouette
*Lateral [[CXR]]:
*Lateral [[CXR]]:
**Vertical opaque line ([[pericardial fluid]]) separating a vertical lucent line directly behind [[sternum]] ([[Epicardial fat pad|epicardial fat]]) anteriorly
**Vertical opaque line ([[pericardial fluid]]) separating a vertical lucent line directly behind [[sternum]] ([[Epicardial fat pad|epicardial fat]]) anteriorly
|
[[File:Webp.net-gifmaker (11).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
| style="background: #DCDCDC; " |[[Musculoskeletal system|Musculoskeletal involvement]]
| style="background: #DCDCDC; " |<small><small>[[Musculoskeletal system|Musculoskeletal involvement]]</small></small>
![[Osteonecrosis]] ([[Avascular necrosis]])
![[Osteonecrosis]] ([[Avascular necrosis]])
|
|
Line 137: Line 188:
*Collapse of the [[articular]] surface
*Collapse of the [[articular]] surface
*Crescent sign of [[AVN]]
*Crescent sign of [[AVN]]
|
[[File:Webp.net-gifmaker (12).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|}
|}


Latest revision as of 16:19, 1 February 2018

Systemic lupus erythematosus Microchapters

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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 X-ray imaging, systemic lupus erythematosus (SLE) may be characterized by different features regarding the present complication. The most common characteristic findings of SLE in X-ray include thumb printing sign in the abdominal X ray, blunting of the costophrenic angle due to pleural effusion, cardiomegaly, hepatomegaly, osteoprosis, tenosinovitis, and other manifestations based on the complications.

X Ray

Findings on an X ray imaging for systemic lupus erythematosus (SLE) depends on the organ system involvement and may include the following features.[1][2][3][4][5][6][7][8][9][10][11][12]

More common findings

Organ Disease Description Preview
Gastrointestinal system Enteritis
Adapted from Radiopaedia
Pulmonary involvement Pleural effusion
Adapted from Radiopaedia
Pulmonary fibrosis
  • Diffuse increased interstitial markings
  • Reduce in lung volume
  • Pulmonary nodularity may be seen
  • Shaggy outline to the heart
    • Due to adjacenet lung fibrosis so the outline of the heart is less well delineated
  • Tracheomegaly
Adapted from Radiopaedia
Pulmonary hypertension
Adapted from Radiopaedia
Acute pneumonitis
Adapted from Radiopaedia
Cardiac involvement Cardiomegaly
Adapted from Radiopaedia
Mitral stenosis
Musculoskeletal involvement Arthritis
Adapted from Radiopaedia
Osteoporosis
Adapted from Radiopaedia

Less common findings

Organ Disease Description Preview
Gastrointestinal system Intestinal pseudo-obstruction
  • Dilated bowel loops with or without the presence of fluid levels
  • Upright chest radiographs for perforation evaluating
Adapted from Radiopaedia
Autosplenectomy
  • Calcified spleen may be visible in the left upper quadrant
Hepatomegaly
  • Enlargement of liver silhouette
  • Medially displaced bowel loops
Adapted from Radiopaedia
Pulmonary involvement Respiratory muscle dysfunction
  • Elevated hemidiaphragms at CXR
  • Linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity
Adapted from Radiopaedia
Pulmonary hemorrhage
  • Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
Adapted from Radiopaedia
Pulmonary emboli
Adapted from Radiopaedia
Shrinking lung syndrome
Cardiac involvement Mitral regurgitation
Adapted from Radiopaedia
Pericardial effusion
  • Globular enlargement of the cardiac shadow giving a water bottle configuration
  • Anteroposterior CXR:
    • Enlarged cardiac silhouette
  • Lateral CXR:
Adapted from Radiopaedia
Musculoskeletal involvement Osteonecrosis (Avascular necrosis)
  • Initial minor osteopenia, followed by variable density
  • Gradually micro-fractures of the subchondral bone accumulate in the dead bone
  • Collapse of the articular surface
  • Crescent sign of AVN
Adapted from Radiopaedia

References

  1. ↑ Appenzeller S (2013). "Magnetic resonance imaging in systemic lupus erythematosus: where do we stand?". Cogn Behav Neurol. 26 (2): 53–4. doi:10.1097/WNN.0b013e31829d5b60. PMID 23812167.
  2. ↑ Thurman JM, Serkova NJ (2015). "Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus". F1000Res. 4: 153. doi:10.12688/f1000research.6587.2. PMC 4536614. PMID 26309728.
  3. ↑ Lin K, Lloyd-Jones DM, Li D, Liu Y, Yang J, Markl M, Carr JC (2015). "Imaging of cardiovascular complications in patients with systemic lupus erythematosus". Lupus. 24 (11): 1126–34. doi:10.1177/0961203315588577. PMC 4567427. PMID 26038342.
  4. ↑ Sarbu N, Bargalló N, Cervera R (2015). "Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus". F1000Res. 4: 162. doi:10.12688/f1000research.6522.2. PMC 4505788. PMID 26236469.
  5. ↑ Qin H, Guo Q, Shen N, Huang X, Wu H, Zhang M, Bao C, Chen S (2014). "Chest imaging manifestations in lupus nephritis". Clin. Rheumatol. 33 (6): 817–23. doi:10.1007/s10067-014-2586-2. PMID 24696368.
  6. ↑ Goh YP, Naidoo P, Ngian GS (2013). "Imaging of systemic lupus erythematosus. Part II: gastrointestinal, renal, and musculoskeletal manifestations". Clin Radiol. 68 (2): 192–202. doi:10.1016/j.crad.2012.06.109. PMID 22901453.
  7. ↑ Gal Y, Twig G, Mozes O, Greenberg G, Hoffmann C, Shoenfeld Y (2013). "Central nervous system involvement in systemic lupus erythematosus: an imaging challenge". Isr. Med. Assoc. J. 15 (7): 382–6. PMID 23943987.
  8. ↑ Shirato M, Hisa N, Fujikura Y, Ohkuma K, Kutsuki S, Hiramatsu K (1992). "[Imaging diagnosis of lupus enteritis--especially about sonographic findings]". Nihon Igaku Hoshasen Gakkai Zasshi (in Japanese). 52 (10): 1394–9. PMID 1448334.
  9. ↑ Adachi JD, Lau A (2014). "Systemic lupus erythematosus, osteoporosis, and fractures". J. Rheumatol. 41 (10): 1913–5. doi:10.3899/jrheum.140919. PMID 25275093.
  10. ↑ Curiel R, Akin EA, Beaulieu G, DePalma L, Hashefi M (2011). "PET/CT imaging in systemic lupus erythematosus". Ann. N. Y. Acad. Sci. 1228: 71–80. doi:10.1111/j.1749-6632.2011.06076.x. PMID 21718325.
  11. ↑ Goh YP, Naidoo P, Ngian GS (2013). "Imaging of systemic lupus erythematosus. Part I: CNS, cardiovascular, and thoracic manifestations". Clin Radiol. 68 (2): 181–91. doi:10.1016/j.crad.2012.06.110. PMID 22901452.
  12. ↑ Rockall AG, Rickards D, Shaw PJ (2001). "Imaging of the pulmonary manifestations of systemic disease". Postgrad Med J. 77 (912): 621–38. PMC 1742125. PMID 11571369.

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