Systemic lupus erythematosus CT

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

Overview

Pulmonary

Pulmonary hypertension (right ventricular prominence, or loud P2)

• ECG-gated CT pulmonary angiography shows:

• • Right ventricular hypertrophy: defined as wall thickness of >4 mm
  • Straightening or bowing (towards the left ventricle) of the interventricular septum
  • Right ventricular dilatation (a right ventricle–to–left ventricle diameter ratio of more than 1:1 at the midventricular level on axial images)
  • Decreased right ventricular ejection fraction
  • Ancillary features
    • dilatation of the inferior vena cava and hepatic veins
    • pericardial effusion

• Enlarged pulmonary trunk (measured at pulmonary artery bifurcation on an axial slice vertical to its long axis)

• Enlarged pulmonary arteries
• Mural calcification in central pulmonary arteries
• Centrilobular ground-glass nodules
• Neovascularity: tiny serpiginous intrapulmonary vessels that often emerge from centrilobular arterioles but do not conform to usual pulmonary arterial anatomy

Pulmonary fibrosis

• Honeycombing: Fibrotic cystic changes
• Traction bronchiectasis: Dilatation of bronchi and bronchioles within fibrotic lung tissue
• Lung architectural distortion
• Reticulation
• Interlobular septal thickening

Shrinking lung

• Reduced lung volumes with diaphragmatic elevation +/- occasional basal atelectasis but without any major parenchymal lung or pleural disease 
• Pulmonary infarction 
• Wedge-shaped (less often rounded) juxtapleural opacification (Hampton hump) without air bronchograms 
• Consolidation with an specific pattern called "bubbly consolidation" that is the co-existing non-infarcted lung parenchyma side-by-side with infarcted lung in the same lobule 
• Cavitation

Pneumonitis

unilateral or bilateral patchy and focal consolidation typically in the lung bases

accompanying pleural effusion may be present

Cardiac

Cardiomyopathy (ventricular dysfunction)

Valvular disease (diastolic murmur, or systolic murmur >3/6)

Pericarditis

Abnormal thickening and enhancement of the pericardium as well as a pericardial effusion in contrast-enhanced chest CT

neurology

CT scans are useful for detecting structural and focal abnormalities (such as infarcts/hypodense areas, hemorrhage, tumors, cerebral calcification, abscess, and basilar meningitis) [38]. Brain atrophy has been noted in some patients; this finding has been thought by some (but disputed by others) to reflect the effects of steroid therapy [6] or age [4]. We have seen brain atrophy out of proportion to a patient's age, and prior to steroid therapy.

Abdominal computed tomography (CT) scan fi ndings compatible with mesenteric vasculitis include prominence of mesenteric vessels with a comb-like appearance supplying dilated bowel loops, small bowel thickening and ascites. Excessive fatty infi ltration (steatosis) in liver/

Gastrointestinal

Pancreatitis

• Peripancreatic edema
• Phlegmon formation
• Mesenteric fatty infiltration around the pancreas
• Glandular enlargement

Bowel ischemia due to mesentric vascuitis

• Ascites
• Dilated bowel
• Mural thickening
• Abnormal wall enhancement
• Mesentric vessel engorgement

Liver and spleen ischemia

• Small, peripheral, wedge-shaped areas of low attenuation that represent ischemic areas