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__NOTOC__
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{{Systemic lupus erythematosus}}
{{Systemic lupus erythematosus}}
{{CMG}} {{AE}}{{MIR}}
{{CMG}}; {{AE}} {{MIR}}
==Overview==
==Overview==
On abdominal ultrasound, systemic lupus erythematosus (SLE) may present with hepatosplenomegaly, ascitis, hyperecho kidney tissue, and rarely cholecystitis. On synovial ultrasound, SLE may present with synovial effusions and synovitis. On SLE may present with decrease ejection fraction, wall motion abnormality, effusion pericarditis, and valve leaflet thickening.
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, [[Pericarditis|effusion pericarditis]], and valve leaflet thickening.


==Ultrasound==
==Ultrasound==
Ultrasound can be used for the diagnosis of systemic lupus erythematosus complications in 2 ways: echocardiography for evaluation of cardiac complications and ultrasound in the diagnosis of abdominal muscular and synovial problems
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.<ref name="pmid21144639">{{cite journal |vauthors=Giancotti A, Spagnuolo A, Bisogni F, D'Ambrosio V, Pasquali G, Panici PB |title=Pregnancy and systemic lupus erythematosus: role of ultrasound monitoring |journal=Eur. J. Obstet. Gynecol. Reprod. Biol. |volume=154 |issue=2 |pages=233–4 |year=2011 |pmid=21144639 |doi=10.1016/j.ejogrb.2010.10.020 |url=}}</ref> The table below presents the main ultrasound findings regarding the organ system involvement in SLE:<ref name="pmid25716942">{{cite journal |vauthors=Lins CF, Santiago MB |title=Ultrasound evaluation of joints in systemic lupus erythematosus: a systematic review |journal=Eur Radiol |volume=25 |issue=9 |pages=2688–92 |year=2015 |pmid=25716942 |doi=10.1007/s00330-015-3670-y |url=}}</ref><ref name="pmid22934226">{{cite journal |vauthors=Virdi RP, Bashir A, Shahzad G, Iqbal J, Mejia JO |title=Diffuse alveolar hemorrhage: a rare life-threatening condition in systemic lupus erythematosus |journal=Case Rep Pulmonol |volume=2012 |issue= |pages=836017 |year=2012 |pmid=22934226 |pmc=3420594 |doi=10.1155/2012/836017 |url=}}</ref><ref name="pmid19473577">{{cite journal |vauthors=Ossandon A, Iagnocco A, Alessandri C, Priori R, Conti F, Valesini G |title=Ultrasonographic depiction of knee joint alterations in systemic lupus erythematosus |journal=Clin. Exp. Rheumatol. |volume=27 |issue=2 |pages=329–32 |year=2009 |pmid=19473577 |doi= |url=}}</ref><ref name="pmid24231444">{{cite journal |vauthors=Iagnocco A, Ceccarelli F, Rizzo C, Truglia S, Massaro L, Spinelli FR, Vavala C, Valesini G, Conti F |title=Ultrasound evaluation of hand, wrist and foot joint synovitis in systemic lupus erythematosus |journal=Rheumatology (Oxford) |volume=53 |issue=3 |pages=465–72 |year=2014 |pmid=24231444 |doi=10.1093/rheumatology/ket376 |url=}}</ref>


{| class="wikitable"
{| class="wikitable"
!Organ
! style="background: #4479BA; color: #FFFFFF; " |Organ
!Sonography findings
! style="background: #4479BA; color: #FFFFFF; " |Sonography findings
! style="background: #4479BA; color: #FFFFFF; " |Preview
|-
|-
|Gastrointestinal system
| style="background: #DCDCDC; " |<small><small>[[Gastrointestinal]]</small></small>
|
|
*General
*General
**Free fluid in the abdomen suggestive of ascitis
**Free fluid in the [[abdomen]] suggestive of [[ascites]]
*Liver
*[[Liver]]
**Hepatomegaly
**[[Hepatomegaly]]
**Hepatic steatosis
**[[Hepatic steatosis]]
*Pancreas
*[[Pancreas]]
**Hypoechoic necrosis regions
**Hypoechoic [[necrosis]] regions
**May accompany vascular complications, e.g. thrombosis
**May accompany vascular complications, e.g. [[thrombosis]]
*Spleen
*[[Spleen]]
**Splenomegaly
**[[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
**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
*[[Cholecystitis]]
**Gallbladder wall thickening (>3 mm) and pericholecystic fluid
**[[Gallbladder wall thickening]] (>3 mm) and pericholecystic fluid
**Positive Murphy sign
**Positive murphy sign
**gallbladder distension
**[[Gallbladder]] distension
|
[[File:3fc11253ba09067fb09f32399ba387 big gallery.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
 
[[File:Acute-acalculous-cholecystitis-1.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|Pulmonary system<ref name="pmid22934226">{{cite journal |vauthors=Virdi RP, Bashir A, Shahzad G, Iqbal J, Mejia JO |title=Diffuse alveolar hemorrhage: a rare life-threatening condition in systemic lupus erythematosus |journal=Case Rep Pulmonol |volume=2012 |issue= |pages=836017 |year=2012 |pmid=22934226 |pmc=3420594 |doi=10.1155/2012/836017 |url=}}</ref>
| style="background: #DCDCDC; " |<small><small>[[Renal]]</small></small>
|
* 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]]
|
|-
| style="background: #DCDCDC; " |<small><small>[[Pulmonary ]]</small></small>  
|
|
* [[Pleural effusion]]
* [[Pleural effusion]]
** Echo-free space between the visceral and parietal pleura
** Echo-free space between the [[Visceral pleura|visceral]] and [[parietal pleura]]
|
[[File:Subpulmonic effusion on ultrasonography.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
|-
|Joints<ref name="pmid19473577">{{cite journal |vauthors=Ossandon A, Iagnocco A, Alessandri C, Priori R, Conti F, Valesini G |title=Ultrasonographic depiction of knee joint alterations in systemic lupus erythematosus |journal=Clin. Exp. Rheumatol. |volume=27 |issue=2 |pages=329–32 |year=2009 |pmid=19473577 |doi= |url=}}</ref>
| style="background: #DCDCDC; " |<small><small>[[Joints]]</small></small>  
|
* [[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]]
|
|
* Synovial proliferation
[[File:Extensor-carpi-ulnaris-tenosynovitis-1.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
* Synovial effusions and synovitis
* Usually no erosions (the difference between SLE and RA)
|-
|-
|Raynaud phenomen
| style="background: #DCDCDC; " |<small><small>[[Raynaud phenomenon]]</small></small>
|
* [[Doppler sonography]]
** In the presence of [[Raynaud phenomenon]], may show flow volume and vessel size irregularities
|
|
* Doppler sonography:
** In the presence of raynaud phenomen, may show flow volume and vessel size irregularities
|}
|}


== Echocardiography ==
== Echocardiography ==
* Decrease [[ejection fraction]]
{| style="border: 3px; font-size: 100%; "
| style="background:#FFFFFF;" |Main [[Echocardiography|echocardiographic]] findings in SLE include:<ref name="pmid2372888">{{cite journal |vauthors=Nihoyannopoulos P, Gomez PM, Joshi J, Loizou S, Walport MJ, Oakley CM |title=Cardiac abnormalities in systemic lupus erythematosus. Association with raised anticardiolipin antibodies |journal=Circulation |volume=82 |issue=2 |pages=369–75 |year=1990 |pmid=2372888 |doi= |url=}}</ref><ref name="pmid24599923">{{cite journal |vauthors=Hübbe-Tena C, Gallegos-Nava S, Márquez-Velasco R, Castillo-Martínez D, Vargas-Barrón J, Sandoval J, Amezcua-Guerra LM |title=Pulmonary hypertension in systemic lupus erythematosus: echocardiography-based definitions predict 6-year survival |journal=Rheumatology (Oxford) |volume=53 |issue=7 |pages=1256–63 |year=2014 |pmid=24599923 |doi=10.1093/rheumatology/keu012 |url=}}</ref>
* Decreased [[ejection fraction]]
* [[Myocarditis]]
* [[Myocarditis]]
** Wall motion abnormality diagnosed mostly by trans-esophageal [[echocardiography]]
** Wall motion abnormality diagnosed mostly by trans-esophageal [[echocardiography]]
* [[Valvular abnormalities]]
* [[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 2372888
** 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 thickening
** Valve regurgitation
** Valve regurgitation
* [[Pericardial effusion]]
* [[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
** [[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
|<br><br>[[File:5e2515ac54c842fffa820c85e60acd big gallery.jpeg|thumb|right|500px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|}


==Refrences==
==Refrences==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 12:03, 17 August 2017

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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.[1] The table below presents the main ultrasound findings regarding the organ system involvement in SLE:[2][3][4][5]

Organ Sonography findings Preview
Gastrointestinal
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
Pulmonary
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

Echocardiography

Main echocardiographic findings in SLE include:[6][7]

Adapted from Radiopaedia

Refrences

  1. ↑ Giancotti A, Spagnuolo A, Bisogni F, D'Ambrosio V, Pasquali G, Panici PB (2011). "Pregnancy and systemic lupus erythematosus: role of ultrasound monitoring". Eur. J. Obstet. Gynecol. Reprod. Biol. 154 (2): 233–4. doi:10.1016/j.ejogrb.2010.10.020. PMID 21144639.
  2. ↑ Lins CF, Santiago MB (2015). "Ultrasound evaluation of joints in systemic lupus erythematosus: a systematic review". Eur Radiol. 25 (9): 2688–92. doi:10.1007/s00330-015-3670-y. PMID 25716942.
  3. ↑ Virdi RP, Bashir A, Shahzad G, Iqbal J, Mejia JO (2012). "Diffuse alveolar hemorrhage: a rare life-threatening condition in systemic lupus erythematosus". Case Rep Pulmonol. 2012: 836017. doi:10.1155/2012/836017. PMC 3420594. PMID 22934226.
  4. ↑ Ossandon A, Iagnocco A, Alessandri C, Priori R, Conti F, Valesini G (2009). "Ultrasonographic depiction of knee joint alterations in systemic lupus erythematosus". Clin. Exp. Rheumatol. 27 (2): 329–32. PMID 19473577.
  5. ↑ Iagnocco A, Ceccarelli F, Rizzo C, Truglia S, Massaro L, Spinelli FR, Vavala C, Valesini G, Conti F (2014). "Ultrasound evaluation of hand, wrist and foot joint synovitis in systemic lupus erythematosus". Rheumatology (Oxford). 53 (3): 465–72. doi:10.1093/rheumatology/ket376. PMID 24231444.
  6. ↑ Nihoyannopoulos P, Gomez PM, Joshi J, Loizou S, Walport MJ, Oakley CM (1990). "Cardiac abnormalities in systemic lupus erythematosus. Association with raised anticardiolipin antibodies". Circulation. 82 (2): 369–75. PMID 2372888.
  7. ↑ Hübbe-Tena C, Gallegos-Nava S, Márquez-Velasco R, Castillo-Martínez D, Vargas-Barrón J, Sandoval J, Amezcua-Guerra LM (2014). "Pulmonary hypertension in systemic lupus erythematosus: echocardiography-based definitions predict 6-year survival". Rheumatology (Oxford). 53 (7): 1256–63. doi:10.1093/rheumatology/keu012. PMID 24599923.
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