Systemic lupus erythematosus x ray: Difference between revisions

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==Overview==
==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:


==X Ray==
==X Ray==
Shrinking lung (radiograph):  unexplained dyspnoea. restrictive pattern onpulmonary function tests.
On X ray imaging, systemic lupus erythematosus (SLE) may be characterized by the following features, based on the organ system involvement.


Chest x-ray often shows small but clear lungs with diaphragmatic elevation. Occasional basal atelectasis may be present. 
=== More common complications ===
 
Pleural fibrosis: Pleural thickening
 
====== Pulmonary infarct ======
* wedge-shaped (less often rounded) juxtapleural opacification (Hampton hump) without air bronchograms
* more often in the lower lobes
 
*
 
==== Plumonary alveolar hemorrhage: ====
 
===== Mesentric vascuitis: =====
* Plain radiographic studies:
** Thumb-printing sign: Due to bowel wall edema or intramural hemorrhage
** Segmental bowel dilatation
** Air-fluid levels, pneumatosis
** Narrowing of the lumen
** Pseudo-obstruction
** Portal venous gas
 
===== Arthritis =====
* Pericapsular soft-tissue edema
* Synovitis around small joints
* Juxtaarticular osteoporosis
 
===== Carpal instability =====
* Radioulnar deviation: An static deformity
{| class="wikitable"
{| class="wikitable"
!Organ
!Organ
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!Description
!Description
|-
|-
| rowspan="4" |Gastrointestinal system
| rowspan="2" |Gastrointestinal system
|[[Dysphagia]]
|[[Dysphagia]]
|
|
*Barium swallow / esophagography
*Barium swallow / esophagography
**Oesophageal stricture
**[[Esophageal]] stricture
*** Peptic strictures that appear as smooth, tapered narrowing in the distal esophagus
*** Peptic strictures that appear as smooth, tapered narrowing in the distal esophagus
** Esophageal dilatation 
** Esophageal dilatation 
|-
|[[Intestinal pseudo-obstruction]]
|
*Dilated bowel loops with or without the presence of fluid levels
*Erect chest radiographs for perforation evaluating
|-
|[[Autosplenectomy]]
|
* Calcified spleen may be visible in the left upper quadrant
|-
|-
|[[Enteritis]]
|[[Enteritis]]
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* Small bowel wall thickening
* Small bowel wall thickening
|-
|-
| rowspan="7" |Pulmonary involvement
| rowspan="2" |Pulmonary involvement
|[[Pleural effusion]]
|[[Pleural effusion]]
|
|
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** Mediastinal shifts with large amounts of fluid
** Mediastinal shifts with large amounts of fluid
|-
|-
|[[Pneumonitis|Acute pneumonitis]]
|
*bilateral patchy airspace opacification
|-
| rowspan="2" |Cardiac involvement
|[[Cardiomegaly]]
|
**Cardiac enlargement
|-
|[[Mitral stenosis]]
|
** Cardiomegaly
** Double right heart border (enlarged left atrium and normal right atrium)
** Prominent left atrial appendage
** Splaying of the subcarinal angle (>120 degrees)
|-
| rowspan="2" |Musculoskeletal involvement
|[[Arthritis]]
|
*Soft tissue swelling of the involved joints
*Normal joint spaces
*Symmetric involvement of interphalangeal joints
**Swan neck deformity
**Boutonniere deformities
**Subluxation with ulnar deviation at MCP joints
**Subluxation of the 1st metacarpophalangeal joint
*Widened forefoot
*Hallux valgus
|-
|[[Osteoporosis]]
|
*Periarticular osteoporosis
*Insufficiency fracture:
**Periosteal reaction progressing to callus formation in diaphyseal fractures
**Linear sclerosis and cortical thickening more frequent in metaphyseal and epiphyseal fractures
|}
=== Less common complications ===
{| class="wikitable"
!Organ
!Disease
!Description
|-
| rowspan="2" |Gastrointestinal system
|[[Intestinal pseudo-obstruction]]
|
*Dilated bowel loops with or without the presence of fluid levels
*Erect chest radiographs for perforation evaluating
|-
|[[Autosplenectomy]]
|
* Calcified spleen may be visible in the left upper quadrant
|-
| rowspan="5" |Pulmonary involvement
|Respiratory muscle dysfunction
|Respiratory muscle dysfunction
|
|
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* Linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity
* Linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity
PMC1742125
PMC1742125
|-
|[[Pneumonitis|Acute pneumonitis]]
|
*bilateral patchy airspace opacification
|-
|-
|[[Pulmonary hemorrhage]]
|[[Pulmonary hemorrhage]]
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*Basal atelectasis 
*Basal atelectasis 
|-
|-
| rowspan="4" |Cardiac involvement
| rowspan="2" |Cardiac involvement
|[[Cardiomegaly]]
|
**Cardiac enlargement
|-
|[[Mitral stenosis]]
|
** Cardiomegaly
** Double right heart border (enlarged left atrium and normal right atrium)
** Prominent left atrial appendage
** Splaying of the subcarinal angle (>120 degrees)
|-
|[[Mitral regurgitation]]
|[[Mitral regurgitation]]
|
|
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** Vertical opaque line (pericardial fluid) separating a vertical lucent line directly behind sternum (epicardial fat) anteriorly
** Vertical opaque line (pericardial fluid) separating a vertical lucent line directly behind sternum (epicardial fat) anteriorly
|-
|-
| rowspan="3" |Musculoskeletal involvement
|Musculoskeletal involvement
|[[Arthritis]]
|
*Soft tissue swelling of the involved joints
*Normal joint spaces
*Symmetric involvement of interphalangeal joints
**Swan neck deformity
**Boutonniere deformities
**Subluxation with ulnar deviation at MCP joints
**Subluxation of the 1st metacarpophalangeal joint
*Widened forefoot
*Hallux valgus
|-
|[[Osteonecrosis]] ([[Avascular necrosis]])
|[[Osteonecrosis]] ([[Avascular necrosis]])
|
|
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*Collapse of the articular surface
*Collapse of the articular surface
*Crescent sign of AVN
*Crescent sign of AVN
|-
|[[Osteoporosis]]
|
*Periarticular osteoporosis
*Insufficiency fracture:
**Periosteal reaction progressing to callus formation in diaphyseal fractures
**Linear sclerosis and cortical thickening more frequent in metaphyseal and epiphyseal fractures
|}
|}


Revision as of 21:02, 17 July 2017

Systemic lupus erythematosus Microchapters

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

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:

X Ray

On X ray imaging, systemic lupus erythematosus (SLE) may be characterized by the following features, based on the organ system involvement.

More common complications

Organ Disease Description
Gastrointestinal system Dysphagia
  • Barium swallow / esophagography
    • Esophageal stricture
      • Peptic strictures that appear as smooth, tapered narrowing in the distal esophagus
    • Esophageal dilatation 
Enteritis
  • Small bowel wall thickening
Pulmonary involvement Pleural effusion
  • Lateral decubitus graphy:
    • Can visualise small amounts of fluid layering against the dependent parietal pleura
  • PA and AP CXR:
    • Blunting of the costophrenic angle
    • Blunting of the cardiophrenic angle
    • Fluid within the horizontal or oblique fissures
    • Mediastinal shifts with large amounts of fluid
Acute pneumonitis
  • bilateral patchy airspace opacification
Cardiac involvement Cardiomegaly
    • Cardiac enlargement
Mitral stenosis
    • Cardiomegaly
    • Double right heart border (enlarged left atrium and normal right atrium)
    • Prominent left atrial appendage
    • Splaying of the subcarinal angle (>120 degrees)
Musculoskeletal involvement Arthritis
  • Soft tissue swelling of the involved joints
  • Normal joint spaces
  • Symmetric involvement of interphalangeal joints
    • Swan neck deformity
    • Boutonniere deformities
    • Subluxation with ulnar deviation at MCP joints
    • Subluxation of the 1st metacarpophalangeal joint
  • Widened forefoot
  • Hallux valgus
Osteoporosis
  • Periarticular osteoporosis
  • Insufficiency fracture:
    • Periosteal reaction progressing to callus formation in diaphyseal fractures
    • Linear sclerosis and cortical thickening more frequent in metaphyseal and epiphyseal fractures

Less common complications

Organ Disease Description
Gastrointestinal system Intestinal pseudo-obstruction
  • Dilated bowel loops with or without the presence of fluid levels
  • Erect chest radiographs for perforation evaluating
Autosplenectomy
  • Calcified spleen may be visible in the left upper quadrant
Pulmonary involvement Respiratory muscle dysfunction
  • Elevated hemidiaphragms at CXR
  • Linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity

PMC1742125

Pulmonary hemorrhage
  • Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
Pulmonary hypertension
  • Elevated cardiac apex due to right ventricular hypertrophy
  • Enlarged right atrium
  • Prominent pulmonary outflow tract
  • Enlarged pulmonary arteries
Pulmonary emboli
Shrinking lung syndrome
  • Small but clear lungs with diaphragmatic elevation
  • Basal atelectasis 
Cardiac involvement Mitral regurgitation
  • Left atrial enlargement
    • Convexity or straightening of the left atrial appendage just below the main pulmonary artery (along left heart border)
    • Double density sign: An addition contour superimposed over the right heart due to left atrium enlargement
    • Elevation of the left main bronchus and splaying of the carina
  • Upper zone venous enlargement due to pulmonary venous hypertension
  • Left ventricular enlargement is also eventually present due to volume overload
Pericardial effusion
  • Globular enlargement of the cardiac shadow giving a water bottle configuration
  • Lateral CXR:
    • Vertical opaque line (pericardial fluid) separating a vertical lucent line directly behind sternum (epicardial fat) anteriorly
Musculoskeletal involvement Osteonecrosis (Avascular necrosis)
  • Initial minor osteopenia, followed by variable density
  • Gradually microfractures of the subchondral bone accumulate in the dead bone
  • Collapse of the articular surface
  • Crescent sign of AVN

References

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