Systemic lupus erythematosus x ray: Difference between revisions

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Revision as of 12:55, 3 August 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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 graphy, blunting of the costophrenic angle due to pleural effusion, cardiomegaly, hepatomegaly, osteoprosis, tenosinovitis, and other manifestations based on the complications.

X Ray

On X ray imaging, 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]^[12]

More common complications

Organ	Disease	Description	Preview
Gastrointestinal system	Enteritis	Small bowel wall thickening Thumbprinting sign	Adapted from Radiopaedia
Pulmonary involvement	Pleural effusion	Lateral decubitus graphy: Can visualise 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		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 with widening the heart shadow 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	Adapted from Radiopaedia

Less common complications

Organ	Disease	Description
Gastrointestinal system	Intestinal pseudo-obstruction	Dilated bowel loops with or without the presence of fluid levels Erect chest radiographs for perforation evaluating
	Autosplenectomy	Calcified spleen may be visible in the left upper quadrant
	Hepatomegaly	Enlargement of liver silhouette Displacing bowel loops medially
Pulmonary involvement	Respiratory muscle dysfunction	Elevated hemidiaphragms at CXR Linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity
	Pulmonary hemorrhage	Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
	Pulmonary emboli	Fleishner sign: Enlarged pulmonary artery Hampton hump: Peripheral wedge of airspace opacity and implies lung infarction Westermark sign: Regional oligoemia Pleural effusion
	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 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
Cardiac involvement	Pericardial effusion	Globular enlargement of the cardiac shadow giving a water bottle configuration Lateral CXR: Vertical opaque line (pericardial fluid) separating a vertical lucent line directly behind sternum (epicardial fat) anteriorly
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

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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@@ Line 22: / Line 22: @@
 ** [[Thumbprinting|Thumbprinting sign]]
 |
-[[File:Thumbprinting xray.jpeg|300px]]
+[[File:Thumbprinting xray.jpeg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 | rowspan="4" style="background: #DCDCDC; " |<small><small>[[Pulmonary|Pulmonary involvement]]</small></small>
@@ Line 35: / Line 35: @@
 ** [[Mediastinal]] shifts with large amounts of fluid
 |
-[[File:Pleural effusion graphy.jpg|300px]]
+[[File:Pleural effusion graphy.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 ![[Pulmonary fibrosis]]
 |
 |
-[[File:Ddae1eb0ee1deec1a5d70aa127b608 jumbo.jpg|300px]]
+[[File:Ddae1eb0ee1deec1a5d70aa127b608 jumbo.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 ![[Pulmonary hypertension]]
@@ Line 49: / Line 49: @@
 * Enlarged [[pulmonary arteries]]
 |
-[[File:Pulmonary hypertension graphy.jpg|300px]]
+[[File:Pulmonary hypertension graphy.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 ![[Pneumonitis|Acute pneumonitis]]
@@ Line 55: / Line 55: @@
 *[[Bilateral]] patchy airspace opacification
 |
-[[File:Hypersensitivity-pneumonitis.jpg|300px]]
+[[File:Hypersensitivity-pneumonitis.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 | rowspan="2" style="background: #DCDCDC; " |<small><small>[[Cardiac|Cardiac involvement]]</small></small>
@@ Line 62: / Line 62: @@
 *[[Cardiac enlargement]]
 | rowspan="2" |
-[[File:270780927951f0155ba941fe2264d1 big gallery.jpg|300px]]
+[[File:270780927951f0155ba941fe2264d1 big gallery.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 ![[Mitral stenosis]]
@@ Line 84: / Line 84: @@
 *[[Hallux valgus]]
 |
-[[File:386a52a8b0dc687cee574b7eaa00f9 jumbo.jpg|300px]]
+[[File:386a52a8b0dc687cee574b7eaa00f9 jumbo.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 ![[Osteoporosis]]
@@ Line 93: / Line 93: @@
 **Linear [[sclerosis]] and cortical thickening more frequent in [[metaphyseal]] and [[epiphyseal]] [[fractures]]
 |
-[[File:A015828ba66db9da16b5a57d0cb2c6 jumbo.jpeg|300px]]
+[[File:A015828ba66db9da16b5a57d0cb2c6 jumbo.jpeg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |}