Systemic lupus erythematosus CT

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

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:

More common complications

Organ	Disease	CT
Gastrointestinal	Hepatitis	Nonspecific, ranging from normal to hepatomegaly and cirrhosis May present hepatic granulomas Discrete, sharply defined nodular lesions within the liver
	Mesenteric vasculitis	Ascites Fluid in the abdomen  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
Kidney	Nephritis	Heterogeneous enlarged kidneys Mostly illustrate the rim of normal density tissue Wedge shaped areas of low density
Pulmonary	Pleural effusion	May be associated with thickening of the pleura Fluid density
	Pulmonary hypertension	ECG-gated CT pulmonary angiography 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 Neovascularization Tiny serpiginous intrapulmonary vessels that often emerge from centrilobular arterioles but do not conform to usual pulmonary arterial anatomy
	Pneumonitis	Unilateral or bilateral patchy and focal consolidation typically in the lung bases May accompany pleural effusion
Cardiac	Mitral stenosis	Valve thickening or leaflet fixation
Neurological	Genreral	Brain atrophy May be due to steroid therapy or age

Less common complications

Gastrointestinal	Intestinal pseudo-obstruction	Dilated bowel loops with or without the presence of fluid levels A distinct transition point where bowel calibre changes from normal to abnormal Dilated bowel loops proximal to the transition point: Small bowel >3.5 cm Large bowel >5 cm Collapsed or normal calibre bowel distal to the transitional point Bowel wall thickening Obstruction: Pneumoperitoneum indicating perforation Bowel ischaemia
	Acute pancreatitis	Abnormalities that may be seen in the pancreas include: Typical findings Focal or diffuse parenchymal enlargement Changes in density because of edema Indistinct pancreatic margins owing to inflammation Mesenteric fatty infiltration around the pancreas Liquefactive necrosis of pancreatic parenchyma Lack of parenchymal enhancement Often multifocal Abscess formation Circumscribed fluid collection Little or no necrotic tissues (thus distinguishing it from infected necrosis) Phlegmon formation Haemorrhage High-attenuation fluid in the retroperitoneum or peripancreatic tissues
	Autosplenectomy	Abnormally small and irregular splenic remnant May show calcified spleen
	Acute cholecystitis	Gallbladder distension Gallbladder wall thickening Mural or mucosal hyperenhancement Pericholecystic fluid and inflammatory fat stranding Enhancement of the adjacent liver parenchyma due to reactive hyperaemia Tensile gallbladder fundus sign Fundus bulging the anterior abdominal wall
Pulmonary	Pulmonary emboli	Filling defects within the pulmonary vasculature with acute pulmonary emboli Vascular CT signs include Direct pulmonary artery signs Complete obstruction Partial obstruction Eccentric thrombus Calcified thrombus- calcific pulmonary emboli Pulmonary arterial bands Post stenotic dilatation Signs related to pulmonary hypertension Enlargement of main pulmonary arteries Narrowing of the peripheral pulmonary arteries in affected segments Pulmonary arterial calcification Tortuous pulmonary vessels Right ventricular hypertrophy Signs of systemic collateral supply Enlargement of bronchial and nonbronchial systemic arteries Parenchymal signs (often non-specific on their own) Scars Mosaic perfusion pattern Focal ground-glass opacities Bronchial anomalies
	Shrinking lung syndrome	Reduced lung volumes with diaphragmatic elevation  Occasional basal atelectasis  No major parenchymal lung or pleural disease
	Pulmonary fibrosis	Honeycombing Fibrotic cystic changes Traction bronchiectasis Dilatation of bronchi and bronchioles within fibrotic lung tissue Lung architectural distortion Reticulation Interlobular septal thickening
Cardiac	Acute pericarditis	Enhancement of the thickened pericardium
	Pericardial effusion	Fluid density material surrounding the heart
	Coronary artery disease	Coronary CT angiography (cCTA) Show the amount of stenosis
Neurological	Stroke	Early sign A hyperdense segment of a vessel, representing direct visualization of the intravascular thrombus 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