Systemic lupus erythematosus x ray: Difference between revisions

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Revision as of 12:56, 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	Preview
Gastrointestinal system	Intestinal pseudo-obstruction	Dilated bowel loops with or without the presence of fluid levels Erect chest radiographs for perforation evaluating	Adapted from Radiopaedia
	Autosplenectomy	Calcified spleen may be visible in the left upper quadrant
	Hepatomegaly	Enlargement of liver silhouette Displacing bowel loops medially	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 implies 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 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 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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@@ Line 109: / Line 109: @@
 *Erect [[chest]] radiographs for [[perforation]] evaluating
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-[[File:Colonic-pseudo-obstruction-ogilvies-syndrome.jpg|300px]]
+[[File:Colonic-pseudo-obstruction-ogilvies-syndrome.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 ![[Autosplenectomy]]
@@ Line 121: / Line 121: @@
 * Displacing bowel loops medially
 |
-[[File:Hepatomegaly-on-abdominal-x-ray.jpg|300px]]
+[[File:Hepatomegaly-on-abdominal-x-ray.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 | rowspan="4" style="background: #DCDCDC; " |<small><small>[[Pulmonary]] involvement</small></small>
@@ Line 129: / Line 129: @@
 *Linear [[atelectasis]] and an ill-defined juxtadiaphragmatic areas of increased opacity
 |
-[[File:Faa79e035d4c88b1029b3f6cd6e222 jumbo.jpeg|300px]]
+[[File:Faa79e035d4c88b1029b3f6cd6e222 jumbo.jpeg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 ![[Pulmonary hemorrhage]]
@@ Line 135: / Line 135: @@
 *Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
 |
-[[File:E4b7a4cbffd49c1f7937c04e6b7c17 big gallery.jpeg|300px]]
+[[File:E4b7a4cbffd49c1f7937c04e6b7c17 big gallery.jpeg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 ![[Pulmonary emboli]]
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 *[[Pleural effusion]]
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-[[File:8272710ac07076fc011a7e0ad2fc7a jumbo.jpg|300px]]
+[[File:8272710ac07076fc011a7e0ad2fc7a jumbo.jpg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 !Shrinking lung syndrome
@@ Line 162: / Line 162: @@
 *Left [[ventricular]] enlargement is also eventually present due to volume overload
 |
-[[File:56dce39ec7860a50a4bf060db455b7 jumbo.jpeg|300px]]
+[[File:56dce39ec7860a50a4bf060db455b7 jumbo.jpeg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 ![[Pericardial effusion]]
@@ Line 170: / Line 170: @@
 **Vertical opaque line ([[pericardial fluid]]) separating a vertical lucent line directly behind [[sternum]] ([[Epicardial fat pad|epicardial fat]]) anteriorly
 |
-[[File:2958c05a9bf1f2dc6b2f83ac4f8e81 jumbo.jpeg|300px]]
+[[File:2958c05a9bf1f2dc6b2f83ac4f8e81 jumbo.jpeg|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |-
 | style="background: #DCDCDC; " |<small><small>[[Musculoskeletal system|Musculoskeletal involvement]]</small></small>
@@ Line 180: / Line 180: @@
 *Crescent sign of [[AVN]]
 |
-[[File:Lupus-osteonecrosis-1.JPG|300px]]
+[[File:Lupus-osteonecrosis-1.JPG|thumb|300px|<SMALL><SMALL>''[https://radiopaedia.org/  Adapted from Radiopaedia]''</SMALL></SMALL>]]
 |}