Systemic lupus erythematosus x ray

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

X Ray

Shrinking lung (radiograph):  unexplained dyspnoea. restrictive pattern onpulmonary function tests.

Chest x-ray often shows small but clear lungs with diaphragmatic elevation. Occasional basal atelectasis may be present. 

Pleural fibrosis: Pleural thickening

Pulmonary infarct

• wedge-shaped (less often rounded) juxtapleural opacification (Hampton hump) without air bronchograms
• more often in the lower lobes

Plumonary alveolar hemorrhage:

Mesentric vascuitis:

• Plain radiographic studies:
  • Thumb-printing sign: Due to bowel wall edema or intramural hemorrhage
  • Segmental bowel dilatation
  • Air-fluid levels, pneumatosis
  • Narrowing of the lumen
  • Pseudo-obstruction
  • Portal venous gas

Arthritis

• Pericapsular soft-tissue edema
• Synovitis around small joints
• Juxtaarticular osteoporosis

Carpal instability

• Radioulnar deviation: An static deformity

Organ	Disease	Description
Gastrointestinal system	Dysphagia	Barium swallow / esophagography Oesophageal stricture Peptic strictures that appear as smooth, tapered narrowing in the distal esophagus Esophageal dilatation
	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
	Enteritis	Small bowel wall thickening
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
	Respiratory muscle dysfunction	Elevated hemidiaphragms at CXR Linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity PMC1742125
	Acute pneumonitis	bilateral patchy airspace opacification
	Pulmonary hemorrhage	Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
	Pulmonary hypertension	Elevated cardiac apex due to right ventricular hypertrophy Enlarged right atrium Prominent pulmonary outflow tract Enlarged pulmonary arteries
	Pulmonary emboli	Fleishner sign: enlarged pulmonary artery Hampton hump: peripheral wedge of airspace opacity and implies lung infarction Westermark sign: regional oligaemia pleural effusion
	Shrinking lung syndrome	Small but clear lungs with diaphragmatic elevation Basal atelectasis
Cardiac involvement	Cardiomegaly	Cardiac enlargement
	Mitral stenosis	Cardiomegaly Double right heart border (enlarged left atrium and normal right atrium) Prominent left atrial appendage Splaying of the subcarinal angle (>120 degrees)
	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 venous hypertension Left ventricular enlargement is also eventually present due to volume overload
	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	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
	Osteonecrosis (Avascular necrosis)	Initial minor osteopenia, followed by variable density Gradually microfractures of the subchondral bone accumulate in the dead bone Collapse of the articular surface Crescent sign of AVN
	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