Systemic lupus erythematosus x ray: Difference between revisions

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Latest revision as of 16:19, 1 February 2018

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	Small bowel wall thickening Thumbprinting sign	Adapted from Radiopaedia
Pulmonary involvement	Pleural effusion	Lateral decubitus view: Visible small amounts of fluid layering against the dependent parietal pleura PA and AP CXR: Blunting of the costophrenic angle Blunting of the cardiophrenic angle Fluid within the horizontal or oblique fissures Mediastinal shifts with large amounts of fluid	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	Elevated cardiac apex due to right ventricular hypertrophy Enlarged right atrium Prominent pulmonary outflow tract Enlarged pulmonary arteries	Adapted from Radiopaedia
	Acute pneumonitis	Bilateral patchy airspace opacification	Adapted from Radiopaedia
Cardiac involvement	Cardiomegaly	Cardiac enlargement	Adapted from Radiopaedia
Cardiac involvement	Mitral stenosis	Cardiomegaly Double right heart border (enlarged left atrium and normal right atrium) Prominent left atrial appendage Splaying of the subcarinal angle (>120 degrees)	Adapted from Radiopaedia
Musculoskeletal involvement	Arthritis	Soft tissue swelling of the involved joints Normal joint spaces Symmetric involvement of interphalangeal joints Swan neck deformity Boutonniere deformities Subluxation with ulnar deviation at MCP joints Subluxation of the 1st metacarpophalangeal joint Widened forefoot Hallux valgus	Adapted from Radiopaedia
Musculoskeletal involvement	Osteoporosis	Periarticular osteoporosis Insufficiency fracture: Periosteal reaction progressing to callus formation in diaphyseal fractures Linear sclerosis and cortical thickening more frequent in metaphyseal and epiphyseal fractures Decrease	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	Fleishner sign: Enlarged pulmonary artery Hampton hump: Peripheral wedge of airspace opacity and implied lung infarction Westermark sign: Regional oligoemia Pleural effusion	Adapted from Radiopaedia
	Shrinking lung syndrome	Small but clear lungs with diaphragmatic elevation Basal atelectasis
Cardiac involvement	Mitral regurgitation	Left atrial enlargement 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 atrium enlargement Elevation of the left main bronchus and splaying of the carina Upper zone venous enlargement due to pulmonary hypertension Left ventricular enlargement is also eventually present due to volume overload	Adapted from Radiopaedia
Cardiac involvement	Pericardial effusion	Globular enlargement of the cardiac shadow giving a water bottle configuration Anteroposterior CXR: Enlarged cardiac silhouette Lateral CXR: Vertical opaque line (pericardial fluid) separating a vertical lucent line directly behind sternum (epicardial fat) anteriorly	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

↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Adachi JD, Lau A (2014). "Systemic lupus erythematosus, osteoporosis, and fractures". J. Rheumatol. 41 (10): 1913–5. doi:10.3899/jrheum.140919. PMID 25275093.
↑ 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.
↑ 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.
↑ 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.

Template:WH Template:WS

[pmid23812167-1] 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.

[pmid26309728-2] 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.

[pmid26038342-3] 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.

[pmid26236469-4] 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.

[pmid24696368-5] 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.

[pmid22901453-6] 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.

[pmid23943987-7] 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.

[pmid1448334-8] 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.

[pmid25275093-9] Adachi JD, Lau A (2014). "Systemic lupus erythematosus, osteoporosis, and fractures". J. Rheumatol. 41 (10): 1913–5. doi:10.3899/jrheum.140919. PMID 25275093.

[pmid21718325-10] 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.

[pmid22901452-11] 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.

[pmid11571369-12] 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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 __NOTOC__
 {{Systemic lupus erythematosus}}
-{{CMG}}
+{{CMG}} {{AE}} {{MIR}}
 ==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 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==
+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 findings ===
+{| class="wikitable"
+! style="background: #4479BA; color: #FFFFFF; " |Organ
+! style="background: #4479BA; color: #FFFFFF; " |Disease
+! style="background: #4479BA; color: #FFFFFF; " |Description
+! style="background: #4479BA; color: #FFFFFF; " |Preview
+|-
+| style="background: #DCDCDC; " |<small><small>[[Gastrointestinal system]]</small></small>
+![[Enteritis]]
+|
+* [[Small bowel]] wall thickening
+** [[Thumbprinting|Thumbprinting sign]]
+|
+[[File:Thumbpronting.gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+| rowspan="4" style="background: #DCDCDC; " |<small><small>[[Pulmonary|Pulmonary involvement]]</small></small>
+![[Pleural effusion]]
+|
+* Lateral decubitus view:
+** Visible small amounts of fluid layering against the dependent [[parietal pleura]]
+* PA and AP CXR:
+** Blunting of the [[costophrenic angle]]
+** Blunting of the cardiophrenic angle
+** Fluid within the [[Horizontal fissure of right lung|horizontal]] or [[Oblique fissure|oblique fissures]]
+** [[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]]
+|
+*Elevated [[cardiac apex]] due to [[right ventricular hypertrophy]]
+* [[Enlarged right atrium]]
+* Prominent pulmonary outflow tract
+* Enlarged [[pulmonary arteries]]
+|
+[[File:PHTN.gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Pneumonitis|Acute pneumonitis]]
+|
+*[[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; " |<small><small>[[Cardiac|Cardiac involvement]]</small></small>
+![[Cardiomegaly]]
+|
+*[[Cardiac enlargement]]
+| rowspan="2" |
+[[File:270780927951f0155ba941fe2264d1 big gallery.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Mitral stenosis]]
+|
+*[[Cardiomegaly]]
+*Double right heart border (enlarged [[left atrium]] and normal [[right atrium]])
+*Prominent [[left atrial]] appendage
+*Splaying of the subcarinal angle (>120 degrees)
+|-
+| rowspan="2" style="background: #DCDCDC; " |<small><small>[[Musculoskeletal system|Musculoskeletal]] involvement</small></small>
+![[Arthritis]]
+|
+*Soft tissue swelling of the involved joints
+*Normal joint spaces
+*Symmetric involvement of [[interphalangeal joints]]
+**[[Swan neck deformity]]
+**[[Boutonniere deformity|Boutonniere deformities]]
+**[[Subluxation]] with [[ulnar deviation]] at [[MCP joints]]
+**[[Subluxation]] of the 1st [[Metacarpophalangeal joints|metacarpophalangeal joint]]
+*Widened forefoot
+*[[Hallux valgus]]
+|
+[[File:Webp.net-gifmaker (3).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Osteoporosis]]
+|
+*Periarticular [[osteoporosis]]
+*Insufficiency fracture:
+**[[Periosteal reaction]] progressing to callus formation in diaphyseal 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 findings ===
+{| class="wikitable"
+! style="background: #4479BA; color: #FFFFFF; " |Organ
+! style="background: #4479BA; color: #FFFFFF; " |Disease
+! style="background: #4479BA; color: #FFFFFF; " |Description
+! style="background: #4479BA; color: #FFFFFF; " |Preview
+|-
+| rowspan="3" style="background: #DCDCDC; " |<small><small>[[Gastrointestinal]] system</small></small>
+![[Intestinal pseudo-obstruction]]
+|
+*Dilated [[bowel]] loops with or without the presence of fluid levels
+*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]]
+|
+* Calcified [[spleen]] may be visible in the left upper quadrant
+|
+|-
+![[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]]
+|
+*Elevated hemidiaphragms at [[CXR]]
+*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]]
+|
+*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]]
+|
+*[[Fleischner sign|Fleishner sign]]: Enlarged [[pulmonary artery]]
+*[[Hampton's hump|Hampton hump]]: Peripheral wedge of airspace opacity and implied [[lung infarction]]
+*[[Westermark sign]]: Regional oligoemia
+*[[Pleural effusion]]
+|
+[[File:Webp.net-gifmaker (9).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+!Shrinking lung syndrome
+|
+*Small but clear [[lungs]] with [[diaphragmatic elevation]]
+*Basal [[atelectasis]]
+|
+|-
+| rowspan="2" style="background: #DCDCDC; " |<small><small>[[Cardiac]] involvement</small></small>
+![[Mitral regurgitation]]
+|
+*[[Left atrial enlargement]]
+**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]]
+**Elevation of the left main [[bronchus]] and splaying of the [[carina]]
+*Upper zone venous enlargement due to [[pulmonary hypertension]]
+*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]]
+|
+*Globular enlargement of the cardiac shadow giving a water bottle configuration
+*Anteroposterior [[CXR]]:
+**Enlarged cardiac silhouette
+*Lateral [[CXR]]:
+**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; " |<small><small>[[Musculoskeletal system|Musculoskeletal involvement]]</small></small>
+![[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]]
+|
+[[File:Webp.net-gifmaker (12).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|}
 ==References==