Systemic lupus erythematosus x ray

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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 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.[1][2][3][4][5][6][7][8][9][10][11][12]

More common findings

Organ Disease Description Preview
Gastrointestinal system Enteritis
Pulmonary involvement Pleural effusion
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
Pulmonary hypertension
Acute pneumonitis
Cardiac involvement Cardiomegaly
Mitral stenosis
Musculoskeletal involvement Arthritis
Osteoporosis

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
Autosplenectomy
  • Calcified spleen may be visible in the left upper quadrant
Hepatomegaly
  • Enlargement of liver silhouette
  • Medially displaced bowel loops
Pulmonary involvement Respiratory muscle dysfunction
  • Elevated hemidiaphragms at CXR
  • Linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity
Pulmonary hemorrhage
  • Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
Pulmonary emboli
Shrinking lung syndrome
Cardiac involvement Mitral regurgitation
Pericardial effusion
  • Globular enlargement of the cardiac shadow giving a water bottle configuration
  • Anteroposterior CXR:
    • Enlarged cardiac silhouette
  • Lateral CXR:
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

References

  1. Appenzeller S (2013). "Magnetic resonance imaging in systemic lupus erythematosus: where do we stand?". Cogn Behav Neurol. 26 (2): 53–4. PMID 23812167. doi:10.1097/WNN.0b013e31829d5b60. 
  2. Thurman JM, Serkova NJ (2015). "Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus". F1000Res. 4: 153. PMC 4536614Freely accessible. PMID 26309728. doi:10.12688/f1000research.6587.2. 
  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. PMC 4567427Freely accessible. PMID 26038342. doi:10.1177/0961203315588577. 
  4. Sarbu N, Bargalló N, Cervera R (2015). "Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus". F1000Res. 4: 162. PMC 4505788Freely accessible. PMID 26236469. doi:10.12688/f1000research.6522.2. 
  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. PMID 24696368. doi:10.1007/s10067-014-2586-2. 
  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. PMID 22901453. doi:10.1016/j.crad.2012.06.109. 
  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. PMID 25275093. doi:10.3899/jrheum.140919. 
  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. PMID 21718325. doi:10.1111/j.1749-6632.2011.06076.x. 
  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. PMID 22901452. doi:10.1016/j.crad.2012.06.110. 
  12. Rockall AG, Rickards D, Shaw PJ (2001). "Imaging of the pulmonary manifestations of systemic disease". Postgrad Med J. 77 (912): 621–38. PMC 1742125Freely accessible. PMID 11571369. 

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