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:
X Ray
On X ray imaging, systemic lupus erythematosus (SLE) may be characterized by the following features, based on the organ system involvement.
More common complications
| Organ
|
Disease
|
Description
|
| Gastrointestinal system
|
Dysphagia
|
- Barium swallow / esophagography
- Esophageal stricture
- Peptic strictures that appear as smooth, tapered narrowing in the distal esophagus
- Esophageal dilatation
|
| 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
|
| Acute pneumonitis
|
- bilateral patchy airspace opacification
|
| Cardiac involvement
|
Cardiomegaly
|
|
| 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)
|
| 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
|
| 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
|
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
|
| Pulmonary involvement
|
Respiratory muscle dysfunction
|
- Elevated hemidiaphragms at CXR
- Linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity
PMC1742125
|
| 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
|
|
| 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 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
|
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
|
References
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