Systemic lupus erythematosus CT: Difference between revisions

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Latest revision as of 16:20, 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 abdominal CT-scan, systemic lupus erythematosus (SLE) may be characterized by hepatosplenomegaly, pancreatic parenchymal enlargement, and ascites. On cardiac CT-scan, SLE may be characterized by enhancement of the thickened pericardium. On brain CT-scan, SLE may be characterized by brain atrophy, stroke patterns like cortical hypodensity, and increased attenuation of the cortex.

Key CT Findings in Systemic Lupus Erythematosus

On CT-scan, systemic lupus erythematosus (SLE) may be characterized by the following features, based on the organ system involvement:^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]

More common complications

Organ	Disease	CT	Preview
Gastrointestinal	Hepatitis	Nonspecific, ranging from normal to hepatomegaly and cirrhosis May present hepatic granulomas Discrete, sharply defined nodular lesions within the liver	Adapted from Radiopaedia
Gastrointestinal	Mesenteric vasculitis	Ascites Fluid in the abdomen Dilated bowel Mural thickening Abnormal wall enhancement Mesentric vessel engorgement Comb sign: Hypervascular appearance of the mesentery Linear densities on the mesenteric side of the affected segments of small bowel, which lead to the appearance of the teeth of a comb	Adapted from Radiopaedia
Kidney	Nephritis	Heterogeneous enlarged kidneys Mostly illustrate the rim of normal density tissue Wedge shaped areas of low density	Adapted from Radiopaedia
Pulmonary	Pleural effusion	May be associated with thickening of the pleura Fluid density	Adapted from Radiopaedia
	Pulmonary hypertension	ECG-gated CT pulmonary angiography Right ventricular hypertrophy: defined as wall thickness of >4 mm Straightening or bowing (towards the left ventricle) of the interventricular septum Right ventricular dilatation (a right ventricle to left ventricle diameter ratio of more than 1:1 at the midventricular level on axial images) Decreased right ventricular ejection fraction Ancillary features Dilatation of the inferior vena cava and hepatic veins Pericardial effusion Enlarged pulmonary trunk (measured at pulmonary artery bifurcation on an axial slice vertical to its long axis) Enlarged pulmonary arteries Mural calcification in central pulmonary arteries Centrilobular ground-glass nodules Neovascularization Tiny serpiginous intrapulmonary vessels that often emerge from centrilobular arterioles but do not conform to usual pulmonary arterial anatomy	Adapted from Radiopaedia
	Pneumonitis	Unilateral or bilateral patchy and focal consolidation typically in the lung bases May accompany pleural effusion	Adapted from Radiopaedia
Neurological	Genreral	Brain atrophy May be due to steroid therapy or age

Less common complications

Organ	Disease	CT	Preview
Gastrointestinal	Intestinal pseudo-obstruction	Dilated bowel loops with or without the presence of fluid levels A distinct transition point where bowel calibre changes from normal to abnormal Dilated bowel loops proximal to the transition point: Small bowel >3.5 cm Large bowel >5 cm Collapsed or normal calibre bowel distal to the transitional point Bowel wall thickening Obstruction: Pneumoperitoneum indicating perforation Bowel ischaemia	Adapted from Radiopaedia
	Acute pancreatitis	Abnormalities that may be seen in the pancreas include: Typical findings Focal or diffuse parenchymal enlargement Changes in density because of edema Indistinct pancreatic margins owing to inflammation Mesenteric fatty infiltration around the pancreas Liquefactive necrosis of pancreatic parenchyma Lack of parenchymal enhancement Often multifocal Abscess formation Circumscribed fluid collection Little or no necrotic tissues (thus distinguishing it from infected necrosis) Phlegmon formation Haemorrhage High-attenuation fluid in the retroperitoneum or peripancreatic tissues	Adapted from Radiopaedia
	Autosplenectomy	Abnormally small and irregular splenic remnant May show calcified spleen	Adapted from Radiopaedia
	Acute cholecystitis	Gallbladder distension Gallbladder wall thickening Mural or mucosal hyperenhancement Pericholecystic fluid and inflammatory fat stranding Enhancement of the adjacent liver parenchyma due to reactive hyperaemia Tensile gallbladder fundus sign Fundus bulging the anterior abdominal wall	Adapted from Radiopaedia
Pulmonary	Pulmonary emboli	Filling defects within the pulmonary vasculature with acute pulmonary emboli Vascular CT signs include Direct pulmonary artery signs Complete obstruction Partial obstruction Eccentric thrombus Calcified thrombus- calcific pulmonary emboli Pulmonary arterial bands Post stenotic dilatation Signs related to pulmonary hypertension Enlargement of main pulmonary arteries Narrowing of the peripheral pulmonary arteries in affected segments Pulmonary arterial calcification Tortuous pulmonary vessels Right ventricular hypertrophy Signs of systemic collateral supply Enlargement of bronchial and nonbronchial systemic arteries Parenchymal signs (often non-specific on their own) Scars Mosaic perfusion pattern Focal ground-glass opacities Bronchial anomalies	Adapted from Radiopaedia
	Shrinking lung syndrome	Reduced lung volumes with diaphragmatic elevation Occasional basal atelectasis No major parenchymal lung or pleural disease
	Pulmonary fibrosis	Honeycombing Fibrotic cystic changes Traction bronchiectasis Dilatation of bronchi and bronchioles within fibrotic lung tissue Lung architectural distortion Reticulation Interlobular septal thickening	Adapted from Radiopaedia
Cardiac	Acute pericarditis	Enhancement of the thickened pericardium	Adapted from Radiopaedia
Cardiac	Pericardial effusion	Fluid density material surrounding the heart	Adapted from Radiopaedia
Neurological	Stroke	Early sign A hyperdense segment of a vessel, representing direct visualization of the intravascular thrombus Early hyperacute Loss of grey-white matter differentiation Hypoattenuation of deep nuclei Cortical hypodensity with associated parenchymal swelling with resultant gyral effacement Elevation of the attenuation of the cortex	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.

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.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Systemic lupus erythematosus}}
-{{CMG}}
+{{CMG}} {{AE}} {{MIR}}
 ==Overview==
+On abdominal [[CT-scans|CT-scan]], systemic lupus erythematosus (SLE) may be characterized by [[hepatosplenomegaly]], [[pancreatic]] parenchymal enlargement, and [[ascites]]. On cardiac [[CT-scans|CT-scan]], SLE may be characterized by enhancement of the thickened [[pericardium]]. On brain [[Computed tomography|CT-scan,]] SLE may be characterized by [[brain atrophy]], stroke patterns like [[Cortical area|cortical]] hypodensity, and increased [[attenuation]] of the [[Cerebral cortex|cortex]].
-=== Pulmonary ===
+== Key CT Findings in Systemic Lupus Erythematosus ==
+On [[CT-scans|CT-scan]], 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>
-====== Pulmonary hypertension (right ventricular prominence, or loud P2) ======
+=== More common complications ===
-* ECG-gated CT pulmonary angiography shows:
+{| class="wikitable"
+! style="background: #4479BA; color: #FFFFFF; " |Organ
-** Right ventricular hypertrophy: defined as wall thickness of >4 mm
+! style="background: #4479BA; color: #FFFFFF; " |Disease
-** Straightening or bowing (towards the left ventricle) of the interventricular septum
+! style="background: #4479BA; color: #FFFFFF; " |CT
-** Right ventricular dilatation (a right ventricle–to–left ventricle diameter ratio of more than 1:1 at the midventricular level on axial images)
+! style="background: #4479BA; color: #FFFFFF; " |Preview
-** Decreased right ventricular ejection fraction
+|-
+| rowspan="2" style="background: #DCDCDC; " align="center" |<small><small>[[Gastrointestinal]]</small></small>
+![[Hepatitis]]
+|
+* Nonspecific, ranging from normal to [[hepatomegaly]] and [[cirrhosis]]
+* May present hepatic [[granulomas]]
+** Discrete, sharply defined [[nodular lesions]] within the [[liver]]
+|
+[[File:Webp.net-gifmaker (13).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Mesenteric vascular occlusion|Mesenteric vasculitis]]
+|
+* [[Ascites]]
+** Fluid in the [[abdomen]]
+* Dilated bowel
+* Mural thickening
+* Abnormal wall enhancement
+* [[Mesentery|Mesentric]] vessel engorgement
+* Comb sign:
+** Hypervascular appearance of the [[mesentery]]
+** Linear densities on the [[mesenteric]] side of the affected segments of [[small bowel]], which lead to the appearance of the teeth of a comb
+|
+[[File:Webp.net-gifmaker (15).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+| style="background: #DCDCDC; " align="center" |<small><small>[[Kidney]]</small></small>
+![[Nephritis]]
+|
+* Heterogeneous enlarged kidneys
+* Mostly illustrate the rim of normal density tissue
+* Wedge shaped areas of low density
+|
+[[File:Webp.net-gifmaker (16).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+| rowspan="3" style="background: #DCDCDC; " align="center" |<small><small>[[Pulmonary]]</small></small>
+![[Pleural effusion]]
+|
+* May be associated with [[Pleural Fibrosis|thickening of the pleura]]
+* Fluid density
+|
+[[File:Webp.net-gifmaker (17).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Pulmonary hypertension]]
+|
+* ECG-gated CT [[pulmonary angiography]]
+** [[Right ventricular hypertrophy]]: defined as wall thickness of >4 mm
+** Straightening or bowing (towards the [[left ventricle]]) of the [[interventricular septum]]
+** [[Right ventricle|Right ventricular]] dilatation (a [[right ventricle]] to [[left ventricle]] diameter ratio of more than 1:1 at the midventricular level on axial images)
+** Decreased [[right ventricular]] [[ejection fraction]]
 ** Ancillary features
-*** dilatation of the inferior vena cava and hepatic veins
+*** Dilatation of the [[inferior vena cava]] and [[hepatic veins]]
-*** pericardial effusion
+*** [[Pericardial effusion]]
+* Enlarged [[pulmonary trunk]] (measured at [[Pulmonary artery|pulmonary artery bifurcation]] on an axial slice vertical to its long axis)
-* Enlarged pulmonary trunk (measured at pulmonary artery bifurcation on an axial slice vertical to its long axis)
+* Enlarged [[pulmonary arteries]]
+* Mural calcification in central [[pulmonary arteries]]
-* Enlarged pulmonary arteries
+* Centrilobular ground-glass [[nodules]]
-* Mural calcification in central pulmonary arteries
+* [[Neovascularization]]
-* Centrilobular ground-glass nodules
+** Tiny serpiginous intrapulmonary vessels that often emerge from centrilobular [[arterioles]] but do not conform to usual [[Pulmonary artery|pulmonary arterial anatomy]]
-* Neovascularity: tiny serpiginous intrapulmonary vessels that often emerge from centrilobular arterioles but do not conform to usual pulmonary arterial anatomy
+|
+[[File:Pulmonary-arterial-hypertension-7.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Pneumonitis]]
+|
+* Unilateral or bilateral patchy and focal [[Consolidation (medicine)|consolidation]] typically in the lung bases
+* May accompany [[pleural effusion]]
+|
+[[File:Webp.net-gifmaker (19).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+| style="background: #DCDCDC; " align="center" |<small><small>[[Neurological]]</small></small>
+!Genreral
+|
+* [[Brain atrophy]]
+* May be due to [[steroid therapy]] or age
+|
+|}
-==== Pulmonary fibrosis ====
+=== Less common complications ===
-* Honeycombing: Fibrotic cystic changes
+{| class="wikitable"
-* Traction bronchiectasis: Dilatation of bronchi and bronchioles within fibrotic lung tissue
+! style="background: #4479BA; color: #FFFFFF; " |Organ
+! style="background: #4479BA; color: #FFFFFF; " |Disease
+! style="background: #4479BA; color: #FFFFFF; " |CT
+! style="background: #4479BA; color: #FFFFFF; " |Preview
+|-
+| rowspan="4" style="background: #DCDCDC; " align="center" |<small><small>[[Gastrointestinal]]</small></small>
+![[Intestinal pseudo-obstruction]]
+|
+* Dilated bowel loops with or without the presence of fluid levels
+** A distinct transition point where bowel calibre changes from normal to abnormal
+** Dilated bowel loops [[proximal]] to the transition point:
+*** [[Small bowel]] >3.5 cm
+*** [[Large bowel]] >5 cm
+** Collapsed or normal calibre [[bowel]] distal to the transitional point
+** Bowel wall thickening
+** [[Intestinal obstruction|Obstruction]]:
+*** [[Pneumoperitoneum]] indicating [[perforation]]
+*** [[Bowel ischaemia]]
+|
+[[File:Webp.net-gifmaker (20).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Acute pancreatitis]]
+|Abnormalities that may be seen in the [[pancreas]] include:
+* Typical findings
+** Focal or diffuse parenchymal enlargement
+** Changes in density because of [[edema]]
+** Indistinct [[Pancreas|pancreatic]] margins owing to inflammation
+** [[Mesentery|Mesenteric]] fatty infiltration around the [[pancreas]]
+* [[Liquefactive necrosis]] of pancreatic parenchyma
+** Lack of parenchymal enhancement
+** Often multifocal
+* [[Abscess of pancreas|Abscess]] formation
+** Circumscribed fluid collection
+** Little or no [[Necrotic tissue|necrotic tissues]] (thus distinguishing it from infected necrosis)
+** [[Phlegmon]] formation
+* [[Haemorrhage]]
+** High-attenuation fluid in the [[retroperitoneum]] or peripancreatic tissues
+|
+[[File:Webp.net-gifmaker (21).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Autosplenectomy]]
+|
+* Abnormally small and irregular [[Spleen|splenic]] remnant
+* May show [[Calcification|calcified]] [[spleen]]
+|
+[[File:Webp.net-gifmaker (22).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+![[Acute cholecystitis]]
+|
+* [[Gallbladder]] distension
+* [[Gallbladder]] wall thickening
+* [[Mural thrombus|Mural]] or mucosal hyperenhancement
+* Pericholecystic fluid and inflammatory fat stranding
+* Enhancement of the adjacent liver parenchyma due to reactive [[hyperaemia]]
+* Tensile [[Gallbladder|gallbladder fundus]] sign
+** Fundus bulging the [[anterior abdominal wall]]
+|
+[[File:Webp.net-gifmaker (23).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+| rowspan="3" style="background: #DCDCDC; " align="center" |<small><small>[[Pulmonary]]</small></small>
+![[Pulmonary emboli]]
+|
+* Filling defects within the [[pulmonary vasculature]] with acute [[pulmonary emboli]]
+* Vascular CT signs include
+** Direct [[pulmonary artery]] signs
+*** Complete [[obstruction]]
+*** Partial obstruction
+*** Eccentric [[thrombus]]
+*** Calcified [[thrombus]]- calcific pulmonary emboli
+*** [[Pulmonary artery|Pulmonary arterial]] bands
+*** Post stenotic dilatation
+** Signs related to [[pulmonary hypertension]]
+*** Enlargement of main [[pulmonary arteries]]
+*** Narrowing of the [[Pulmonary arteries|peripheral pulmonary arteries]] in affected segments
+*** [[Pulmonary hypertension|Pulmonary arterial]] [[calcification]]
+*** Tortuous [[pulmonary vessels]]
+*** [[Right ventricular hypertrophy]]
+** Signs of systemic collateral supply
+*** Enlargement of [[Bronchial artery|bronchial]] and nonbronchial systemic arteries
+* Parenchymal signs (often non-specific on their own)
+** [[Scars]]
+** Mosaic [[perfusion]] pattern
+** Focal ground-glass opacities
+** [[Bronchial]] anomalies
+|
+[[File:Webp.net-gifmaker (24).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
+!Shrinking lung syndrome
+|
+* Reduced [[lung volumes]] with [[diaphragmatic elevation]]
+* Occasional basal [[atelectasis]]
+* No major [[Interstitial lung disease|parenchymal lung]] or [[pleural disease]]
+|
+|-
+![[Pulmonary fibrosis]]
+|
+* Honeycombing
+** Fibrotic cystic changes
+* Traction [[bronchiectasis]]
+** Dilatation of [[bronchi]] and [[bronchioles]] within fibrotic lung tissue
 * Lung architectural distortion
 * Reticulation
 * Interlobular septal thickening
+|
-===== Shrinking lung =====
+[[File:Webp.net-gifmaker (25).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
-* Reduced lung volumes with diaphragmatic elevation +/- occasional basal atelectasis but without any major parenchymal lung or pleural disease
+|-
-* Pulmonary infarction
+| rowspan="2" style="background: #DCDCDC; " align="center" |<small><small>[[Cardiac]]</small></small>
-* Wedge-shaped (less often rounded) juxtapleural opacification (Hampton hump) without air bronchograms
+![[Acute pericarditis]]
-* Consolidation with an specific pattern called  "bubbly consolidation" that is the co-existing non-infarcted lung parenchyma side-by-side with infarcted lung in the same lobule
+|
-* Cavitation
+* Enhancement of the thickened [[pericardium]]
+|
-===== Pneumonitis =====
+[[File:Webp.net-gifmaker (26).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
-unilateral or bilateral patchy and focal consolidation typically in the lung bases
+|-
+![[Pericardial effusion]]
-accompanying pleural effusion may be present
+|
+* Fluid density material surrounding the [[heart]]
-=== Cardiac ===
+|
-Cardiomyopathy (ventricular dysfunction)
+[[File:Webp.net-gifmaker (27).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
+|-
-Valvular disease (diastolic murmur, or systolic murmur >3/6)
+| style="background: #DCDCDC; " align="center" |<small><small>[[Neurological]]</small></small>
+![[Stroke]]
-===== Pericarditis =====
+|
-Abnormal thickening and enhancement of the pericardium as well as a pericardial effusion in contrast-enhanced chest CT
+* Early sign
+** A hyperdense segment of a [[vessel]], representing direct [[Visualization (cam)|visualization]] of the [[Intravascular coagulation|intravascular thrombus]]
-===== neurology =====
+* Early hyperacute
-CT scans are useful for detecting structural and focal abnormalities (such as infarcts/hypodense areas, hemorrhage, tumors, cerebral calcification, abscess, and basilar meningitis) [38]. Brain atrophy has been noted in some patients; this finding has been thought by some (but disputed by others) to reflect the effects of steroid therapy [6] or age [4]. We have seen brain atrophy out of proportion to a patient's age, and prior to steroid therapy.
+** Loss of grey-white matter differentiation
+** Hypoattenuation of deep nuclei
-Abdominal computed tomography (CT) scan fi ndings compatible with mesenteric vasculitis include prominence of mesenteric vessels with a comb-like appearance supplying dilated bowel loops, small bowel thickening and ascites.  Excessive fatty infi ltration (steatosis) in liver/
+** Cortical hypodensity with associated [[Parenchyma|parenchymal]] swelling with resultant gyral effacement
+** Elevation of the attenuation of the [[cortex]]
-==Key CT Findings in Systemic Lupus Erythematosus==
+|
+[[File:Webp.net-gifmaker (28).gif|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
-==Examples of CT Findings in Systemic Lupus Erythematosus==
+|}
 ==References==