Systemic lupus erythematosus CT

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

Overview

On abdominal CT-scan, systemic lupus erythematosus (SLE) may be characterized by hepatosplenomegaly, pancreatic parenchymal enlargement, and ascites. On cardiac CT-scan, SLE may be characterized by enhancement of the thickened pericardium. On brain CT-scan, SLE may be characterized by brain atrophy, stroke patterns like cortical hypodensity, and increased attenuation of the cortex.

Key CT Findings in Systemic Lupus Erythematosus

On CT-scan, 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]

More common complications

Organ Disease CT Preview
Gastrointestinal Hepatitis
Adapted from Radiopaedia
Mesenteric vasculitis
  • Ascites
  • Dilated bowel
  • Mural thickening
  • Abnormal wall enhancement
  • Mesentric vessel engorgement
  • Comb sign:
    • Hypervascular appearance of the mesentery 
    • Linear densities on the mesenteric side of the affected segments of small bowel, which lead to the appearance of the teeth of a comb 
Adapted from Radiopaedia
Kidney Nephritis
  • Heterogeneous enlarged kidneys
  • Mostly illustrate the rim of normal density tissue
  • Wedge shaped areas of low density
Adapted from Radiopaedia
Pulmonary Pleural effusion
Adapted from Radiopaedia
Pulmonary hypertension
Adapted from Radiopaedia
Pneumonitis
Adapted from Radiopaedia
Neurological Genreral

Less common complications

Organ Disease CT Preview
Gastrointestinal Intestinal pseudo-obstruction
Adapted from Radiopaedia
Acute pancreatitis Abnormalities that may be seen in the pancreas include:
Adapted from Radiopaedia
Autosplenectomy
Adapted from Radiopaedia
Acute cholecystitis
Adapted from Radiopaedia
Pulmonary Pulmonary emboli
Adapted from Radiopaedia
Shrinking lung syndrome
Pulmonary fibrosis
  • Honeycombing
    • Fibrotic cystic changes
  • Traction bronchiectasis
  • Lung architectural distortion
  • Reticulation
  • Interlobular septal thickening
Adapted from Radiopaedia
Cardiac Acute pericarditis
Adapted from Radiopaedia
Pericardial effusion
  • Fluid density material surrounding the heart
Adapted from Radiopaedia
Neurological Stroke
  • Early sign
  • Early hyperacute
    • Loss of grey-white matter differentiation
    • Hypoattenuation of deep nuclei
    • Cortical hypodensity with associated parenchymal swelling with resultant gyral effacement
    • Elevation of the attenuation of the cortex
Adapted from Radiopaedia

References

  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.

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