Lupus nephritis echocardiography or ultrasound

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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 abdominal ultrasound, systemic lupus erythematosus (SLE) may present with hepatosplenomegaly, ascites, hyperecho-kidney tissue due to nephritis, and rarely cholecystitis. On synovial ultrasound, SLE may present with synovial effusions and synovitis. On echocardiography, SLE may present with decreased ejection fraction, cardiac wall motion abnormality, effusion pericarditis, and valve leaflet thickening.

Echocardiography

Main echocardiographic findings in SLE include:^[1]^[2]

Decreased ejection fraction
Myocarditis
- Wall motion abnormality diagnosed mostly by trans-esophageal echocardiography
Valvular abnormalities
- Valve leaflet thickening due to Libman-Sacks endocarditis characterized by the formation of small single or multiple, sterile, granular pink vegetations ranging from 1 to 4 mm
- Valve thickening
- Valve regurgitation
Pericardial effusion
- Echocardiography is the method of choice to confirm the diagnosis, estimate the volume of fluid and most importantly assess the haemodynamic impact of the effusion

Ultrasound

Ultrasound can be used for the diagnosis of systemic lupus erythematosus complications. It can also be used for screening and monitoring the disease activity during pregnancy.^[3] The table below presents the main ultrasound findings regarding the organ system involvement in SLE:^[4]^[5]^[6]^[7]

Organ	Sonography findings	Preview
Gastrointestinal	General Free fluid in the abdomen suggestive of ascites Liver Hepatomegaly Hepatic steatosis Pancreas Hypoechoic necrosis regions May accompany vascular complications, e.g. thrombosis Spleen Splenomegaly In cases of autosplenectomy, ultrasound will either not be able to demonstrate a spleen at all, or identify a small irregular and shadowing nodule in the splenic bed Cholecystitis Gallbladder wall thickening (>3 mm) and pericholecystic fluid Positive murphy sign Gallbladder distension	Adapted from Radiopaedia Adapted from Radiopaedia
Renal	Generally hyperechoic kidneys Loss of corticomedullary differentiation The size of the kidneys vary depending on the duration of the involvement Small and diffusely echogenic kidneys mostly on SLE-related chronic renal failure
Pulmonary	Pleural effusion Echo-free space between the visceral and parietal pleura	Adapted from Radiopaedia
Joints	Synovial proliferation Synovial effusions and subclinical synovitis Usually no erosions (the difference between SLE and RA) Tenosynovitis Global thickening with effusion in the sheath of tendon	Adapted from Radiopaedia
Raynaud phenomenon	Doppler sonography In the presence of Raynaud phenomenon, may show flow volume and vessel size irregularities

References

↑ Nihoyannopoulos P, Gomez PM, Joshi J, Loizou S, Walport MJ, Oakley CM (1990). "Cardiac abnormalities in systemic lupus erythematosus. Association with raised anticardiolipin antibodies". Circulation. 82 (2): 369–75. PMID 2372888.
↑ Hübbe-Tena C, Gallegos-Nava S, Márquez-Velasco R, Castillo-Martínez D, Vargas-Barrón J, Sandoval J, Amezcua-Guerra LM (2014). "Pulmonary hypertension in systemic lupus erythematosus: echocardiography-based definitions predict 6-year survival". Rheumatology (Oxford). 53 (7): 1256–63. doi:10.1093/rheumatology/keu012. PMID 24599923.
↑ Giancotti A, Spagnuolo A, Bisogni F, D'Ambrosio V, Pasquali G, Panici PB (2011). "Pregnancy and systemic lupus erythematosus: role of ultrasound monitoring". Eur. J. Obstet. Gynecol. Reprod. Biol. 154 (2): 233–4. doi:10.1016/j.ejogrb.2010.10.020. PMID 21144639.
↑ Lins CF, Santiago MB (2015). "Ultrasound evaluation of joints in systemic lupus erythematosus: a systematic review". Eur Radiol. 25 (9): 2688–92. doi:10.1007/s00330-015-3670-y. PMID 25716942.
↑ Virdi RP, Bashir A, Shahzad G, Iqbal J, Mejia JO (2012). "Diffuse alveolar hemorrhage: a rare life-threatening condition in systemic lupus erythematosus". Case Rep Pulmonol. 2012: 836017. doi:10.1155/2012/836017. PMC 3420594. PMID 22934226.
↑ Ossandon A, Iagnocco A, Alessandri C, Priori R, Conti F, Valesini G (2009). "Ultrasonographic depiction of knee joint alterations in systemic lupus erythematosus". Clin. Exp. Rheumatol. 27 (2): 329–32. PMID 19473577.
↑ Iagnocco A, Ceccarelli F, Rizzo C, Truglia S, Massaro L, Spinelli FR, Vavala C, Valesini G, Conti F (2014). "Ultrasound evaluation of hand, wrist and foot joint synovitis in systemic lupus erythematosus". Rheumatology (Oxford). 53 (3): 465–72. doi:10.1093/rheumatology/ket376. PMID 24231444.

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[pmid2372888-1] Nihoyannopoulos P, Gomez PM, Joshi J, Loizou S, Walport MJ, Oakley CM (1990). "Cardiac abnormalities in systemic lupus erythematosus. Association with raised anticardiolipin antibodies". Circulation. 82 (2): 369–75. PMID 2372888.

[pmid24599923-2] Hübbe-Tena C, Gallegos-Nava S, Márquez-Velasco R, Castillo-Martínez D, Vargas-Barrón J, Sandoval J, Amezcua-Guerra LM (2014). "Pulmonary hypertension in systemic lupus erythematosus: echocardiography-based definitions predict 6-year survival". Rheumatology (Oxford). 53 (7): 1256–63. doi:10.1093/rheumatology/keu012. PMID 24599923.

[pmid21144639-3] Giancotti A, Spagnuolo A, Bisogni F, D'Ambrosio V, Pasquali G, Panici PB (2011). "Pregnancy and systemic lupus erythematosus: role of ultrasound monitoring". Eur. J. Obstet. Gynecol. Reprod. Biol. 154 (2): 233–4. doi:10.1016/j.ejogrb.2010.10.020. PMID 21144639.

[pmid25716942-4] Lins CF, Santiago MB (2015). "Ultrasound evaluation of joints in systemic lupus erythematosus: a systematic review". Eur Radiol. 25 (9): 2688–92. doi:10.1007/s00330-015-3670-y. PMID 25716942.

[pmid22934226-5] Virdi RP, Bashir A, Shahzad G, Iqbal J, Mejia JO (2012). "Diffuse alveolar hemorrhage: a rare life-threatening condition in systemic lupus erythematosus". Case Rep Pulmonol. 2012: 836017. doi:10.1155/2012/836017. PMC 3420594. PMID 22934226.

[pmid19473577-6] Ossandon A, Iagnocco A, Alessandri C, Priori R, Conti F, Valesini G (2009). "Ultrasonographic depiction of knee joint alterations in systemic lupus erythematosus". Clin. Exp. Rheumatol. 27 (2): 329–32. PMID 19473577.

[pmid24231444-7] Iagnocco A, Ceccarelli F, Rizzo C, Truglia S, Massaro L, Spinelli FR, Vavala C, Valesini G, Conti F (2014). "Ultrasound evaluation of hand, wrist and foot joint synovitis in systemic lupus erythematosus". Rheumatology (Oxford). 53 (3): 465–72. doi:10.1093/rheumatology/ket376. PMID 24231444.

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Lupus nephritis echocardiography or ultrasound

Overview

Echocardiography

Ultrasound

References

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