Lupus nephritis chest x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D. [2]

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

X Ray

Findings on an X ray imaging for systemic lupus erythematosus (SLE) depends on the organ system involvement and may include the following features.

More common findings

Organ	Disease	Description	Preview
Gastrointestinal system	Enteritis	Small bowel wall thickening Thumbprinting sign	Adapted from Radiopaedia
Pulmonary involvement	Pleural effusion	Lateral decubitus view: Visible 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	Diffuse increased interstitial markings Reduce in lung volume Pulmonary nodularity may be seen Shaggy outline to the heart Due to adjacenet lung fibrosis so the outline of the heart is less well delineated Tracheomegaly	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
	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	Adapted from Radiopaedia
	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 Decrease	Adapted from Radiopaedia

Less common findings

Organ	Disease	Description	Preview
Gastrointestinal system	Intestinal pseudo-obstruction	Dilated bowel loops with or without the presence of fluid levels Upright chest radiographs for perforation evaluating	Adapted from Radiopaedia
	Autosplenectomy	Calcified spleen may be visible in the left upper quadrant
	Hepatomegaly	Enlargement of liver silhouette Medially displaced bowel loops	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 implied 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 with 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
	Pericardial effusion	Globular enlargement of the cardiac shadow giving a water bottle configuration Anteroposterior CXR: Enlarged cardiac silhouette 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