Lupus nephritis echocardiography or ultrasound: Difference between revisions

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{{Lupus nephritis}}
{{Lupus nephritis}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}[[User:Okamal|Omer Kamal, M.D.]] [mailto:okamal@bidmc.harvard.edu%7C <nowiki>[2]</nowiki>]


==Overview==
==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, [[Pericarditis|effusion pericarditis]], and valve leaflet thickening.


There are no echocardiography/ultrasound findings associated with [disease name].
== Echocardiography ==
{| 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]]
** 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
|<br><br>[[File:5e2515ac54c842fffa820c85e60acd big gallery.jpeg|thumb|right|500px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|}


OR
==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.<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>


Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
{| class="wikitable"
! style="background: #4479BA; color: #FFFFFF; " |Organ
! style="background: #4479BA; color: #FFFFFF; " |Sonography findings
! style="background: #4479BA; color: #FFFFFF; " |Preview
|-
| style="background: #DCDCDC; " |<small><small>[[Gastrointestinal]]</small></small>
|
*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
|
[[File:3fc11253ba09067fb09f32399ba387 big gallery.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]


OR
[[File:Acute-acalculous-cholecystitis-1.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
 
|-
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
| style="background: #DCDCDC; " |<small><small>[[Renal]]</small></small>
 
|
==Echocardiography/Ultrasound==
* Generally hyperechoic kidneys
 
* Loss of corticomedullary differentiation
*There are no echocardiography/ultrasound findings associated with [disease name].
* The size of the [[kidneys]] vary depending on the duration of the involvement
OR
** Small and diffusely echogenic kidneys mostly on SLE-related [[chronic renal failure]]  
*Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include:
|
**[Finding 1]
|-
**[Finding 2]
| style="background: #DCDCDC; " |<small><small>[[Pulmonary ]]</small></small>
**[Finding 3]
|
OR
* [[Pleural effusion]]
*There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include:
** Echo-free space between the [[Visceral pleura|visceral]] and [[parietal pleura]]
**[Complication 1]
|
**[Complication 2]
[[File:Subpulmonic effusion on ultrasonography.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
**[Complication 3]
|-
| 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]]
|
[[File:Extensor-carpi-ulnaris-tenosynovitis-1.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/ Adapted from Radiopaedia]''</SMALL></SMALL>]]
|-
| 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
|
|}


==References==
==References==

Latest revision as of 17:30, 20 July 2018

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

Echocardiography

Main echocardiographic findings in SLE include:[1][2]

Adapted from Radiopaedia

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.[3] The table below presents the main ultrasound findings regarding the organ system involvement in SLE:[4][5][6][7]

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

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.

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