Systemic lupus erythematosus CT

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

Overview

Pulmonary

Pulmonary hypertension (right ventricular prominence, or loud P2)

• ECG-gated CT pulmonary angiography shows:

• • 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
• Neovascularity: tiny serpiginous intrapulmonary vessels that often emerge from centrilobular arterioles but do not conform to usual pulmonary arterial anatomy

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

• Reduced lung volumes with diaphragmatic elevation +/- occasional basal atelectasis but without any major parenchymal lung or pleural disease 
• Pulmonary infarction 
• Wedge-shaped (less often rounded) juxtapleural opacification (Hampton hump) without air bronchograms 
• 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

Cardiac

Cardiomyopathy (ventricular dysfunction)

Valvular disease (diastolic murmur, or systolic murmur >3/6)

Pericarditis

neurology

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.

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/