Systemic lupus erythematosus x ray: Difference between revisions

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==X Ray==
==X Ray==
On X ray imaging, systemic lupus erythematosus (SLE) may be characterized by the following features, based on the organ system involvement.<ref name="pmid23812167">{{cite journal |vauthors=Appenzeller S |title=Magnetic resonance imaging in systemic lupus erythematosus: where do we stand? |journal=Cogn Behav Neurol |volume=26 |issue=2 |pages=53–4 |year=2013 |pmid=23812167 |doi=10.1097/WNN.0b013e31829d5b60 |url=}}</ref><ref name="pmid26309728">{{cite journal |vauthors=Thurman JM, Serkova NJ |title=Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus |journal=F1000Res |volume=4 |issue= |pages=153 |year=2015 |pmid=26309728 |pmc=4536614 |doi=10.12688/f1000research.6587.2 |url=}}</ref><ref name="pmid26038342">{{cite journal |vauthors=Lin K, Lloyd-Jones DM, Li D, Liu Y, Yang J, Markl M, Carr JC |title=Imaging of cardiovascular complications in patients with systemic lupus erythematosus |journal=Lupus |volume=24 |issue=11 |pages=1126–34 |year=2015 |pmid=26038342 |pmc=4567427 |doi=10.1177/0961203315588577 |url=}}</ref><ref name="pmid26236469">{{cite journal |vauthors=Sarbu N, Bargalló N, Cervera R |title=Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus |journal=F1000Res |volume=4 |issue= |pages=162 |year=2015 |pmid=26236469 |pmc=4505788 |doi=10.12688/f1000research.6522.2 |url=}}</ref><ref name="pmid24696368">{{cite journal |vauthors=Qin H, Guo Q, Shen N, Huang X, Wu H, Zhang M, Bao C, Chen S |title=Chest imaging manifestations in lupus nephritis |journal=Clin. Rheumatol. |volume=33 |issue=6 |pages=817–23 |year=2014 |pmid=24696368 |doi=10.1007/s10067-014-2586-2 |url=}}</ref><ref name="pmid22901453">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part II: gastrointestinal, renal, and musculoskeletal manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=192–202 |year=2013 |pmid=22901453 |doi=10.1016/j.crad.2012.06.109 |url=}}</ref><ref name="pmid23943987">{{cite journal |vauthors=Gal Y, Twig G, Mozes O, Greenberg G, Hoffmann C, Shoenfeld Y |title=Central nervous system involvement in systemic lupus erythematosus: an imaging challenge |journal=Isr. Med. Assoc. J. |volume=15 |issue=7 |pages=382–6 |year=2013 |pmid=23943987 |doi= |url=}}</ref><ref name="pmid1448334">{{cite journal |vauthors=Shirato M, Hisa N, Fujikura Y, Ohkuma K, Kutsuki S, Hiramatsu K |title=[Imaging diagnosis of lupus enteritis--especially about sonographic findings] |language=Japanese |journal=Nihon Igaku Hoshasen Gakkai Zasshi |volume=52 |issue=10 |pages=1394–9 |year=1992 |pmid=1448334 |doi= |url=}}</ref><ref name="pmid25275093">{{cite journal |vauthors=Adachi JD, Lau A |title=Systemic lupus erythematosus, osteoporosis, and fractures |journal=J. Rheumatol. |volume=41 |issue=10 |pages=1913–5 |year=2014 |pmid=25275093 |doi=10.3899/jrheum.140919 |url=}}</ref><ref name="pmid21718325">{{cite journal |vauthors=Curiel R, Akin EA, Beaulieu G, DePalma L, Hashefi M |title=PET/CT imaging in systemic lupus erythematosus |journal=Ann. N. Y. Acad. Sci. |volume=1228 |issue= |pages=71–80 |year=2011 |pmid=21718325 |doi=10.1111/j.1749-6632.2011.06076.x |url=}}</ref><ref name="pmid22901452">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part I: CNS, cardiovascular, and thoracic manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=181–91 |year=2013 |pmid=22901452 |doi=10.1016/j.crad.2012.06.110 |url=}}</ref>
On X ray imaging, systemic lupus erythematosus (SLE) may be characterized by the following features, based on the organ system involvement.<ref name="pmid23812167">{{cite journal |vauthors=Appenzeller S |title=Magnetic resonance imaging in systemic lupus erythematosus: where do we stand? |journal=Cogn Behav Neurol |volume=26 |issue=2 |pages=53–4 |year=2013 |pmid=23812167 |doi=10.1097/WNN.0b013e31829d5b60 |url=}}</ref><ref name="pmid26309728">{{cite journal |vauthors=Thurman JM, Serkova NJ |title=Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus |journal=F1000Res |volume=4 |issue= |pages=153 |year=2015 |pmid=26309728 |pmc=4536614 |doi=10.12688/f1000research.6587.2 |url=}}</ref><ref name="pmid26038342">{{cite journal |vauthors=Lin K, Lloyd-Jones DM, Li D, Liu Y, Yang J, Markl M, Carr JC |title=Imaging of cardiovascular complications in patients with systemic lupus erythematosus |journal=Lupus |volume=24 |issue=11 |pages=1126–34 |year=2015 |pmid=26038342 |pmc=4567427 |doi=10.1177/0961203315588577 |url=}}</ref><ref name="pmid26236469">{{cite journal |vauthors=Sarbu N, Bargalló N, Cervera R |title=Advanced and Conventional Magnetic Resonance Imaging in Neuropsychiatric Lupus |journal=F1000Res |volume=4 |issue= |pages=162 |year=2015 |pmid=26236469 |pmc=4505788 |doi=10.12688/f1000research.6522.2 |url=}}</ref><ref name="pmid24696368">{{cite journal |vauthors=Qin H, Guo Q, Shen N, Huang X, Wu H, Zhang M, Bao C, Chen S |title=Chest imaging manifestations in lupus nephritis |journal=Clin. Rheumatol. |volume=33 |issue=6 |pages=817–23 |year=2014 |pmid=24696368 |doi=10.1007/s10067-014-2586-2 |url=}}</ref><ref name="pmid22901453">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part II: gastrointestinal, renal, and musculoskeletal manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=192–202 |year=2013 |pmid=22901453 |doi=10.1016/j.crad.2012.06.109 |url=}}</ref><ref name="pmid23943987">{{cite journal |vauthors=Gal Y, Twig G, Mozes O, Greenberg G, Hoffmann C, Shoenfeld Y |title=Central nervous system involvement in systemic lupus erythematosus: an imaging challenge |journal=Isr. Med. Assoc. J. |volume=15 |issue=7 |pages=382–6 |year=2013 |pmid=23943987 |doi= |url=}}</ref><ref name="pmid1448334">{{cite journal |vauthors=Shirato M, Hisa N, Fujikura Y, Ohkuma K, Kutsuki S, Hiramatsu K |title=[Imaging diagnosis of lupus enteritis--especially about sonographic findings] |language=Japanese |journal=Nihon Igaku Hoshasen Gakkai Zasshi |volume=52 |issue=10 |pages=1394–9 |year=1992 |pmid=1448334 |doi= |url=}}</ref><ref name="pmid25275093">{{cite journal |vauthors=Adachi JD, Lau A |title=Systemic lupus erythematosus, osteoporosis, and fractures |journal=J. Rheumatol. |volume=41 |issue=10 |pages=1913–5 |year=2014 |pmid=25275093 |doi=10.3899/jrheum.140919 |url=}}</ref><ref name="pmid21718325">{{cite journal |vauthors=Curiel R, Akin EA, Beaulieu G, DePalma L, Hashefi M |title=PET/CT imaging in systemic lupus erythematosus |journal=Ann. N. Y. Acad. Sci. |volume=1228 |issue= |pages=71–80 |year=2011 |pmid=21718325 |doi=10.1111/j.1749-6632.2011.06076.x |url=}}</ref><ref name="pmid22901452">{{cite journal |vauthors=Goh YP, Naidoo P, Ngian GS |title=Imaging of systemic lupus erythematosus. Part I: CNS, cardiovascular, and thoracic manifestations |journal=Clin Radiol |volume=68 |issue=2 |pages=181–91 |year=2013 |pmid=22901452 |doi=10.1016/j.crad.2012.06.110 |url=}}</ref><ref name="pmid11571369">{{cite journal |vauthors=Rockall AG, Rickards D, Shaw PJ |title=Imaging of the pulmonary manifestations of systemic disease |journal=Postgrad Med J |volume=77 |issue=912 |pages=621–38 |year=2001 |pmid=11571369 |pmc=1742125 |doi= |url=}}</ref>


=== More common complications ===
=== More common complications ===
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|-
|-
| style="background: #DCDCDC; " |[[Gastrointestinal system]]
| style="background: #DCDCDC; " |[[Gastrointestinal system]]
|[[Enteritis]]
![[Enteritis]]
|
|
* [[Small bowel]] wall thickening
* [[Small bowel]] wall thickening
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|-
|-
| rowspan="3" style="background: #DCDCDC; " |[[Pulmonary|Pulmonary involvement]]
| rowspan="3" style="background: #DCDCDC; " |[[Pulmonary|Pulmonary involvement]]
|[[Pleural effusion]]
![[Pleural effusion]]
|
|
* Lateral decubitus graphy:
* Lateral decubitus graphy:
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** [[Mediastinal]] shifts with large amounts of fluid
** [[Mediastinal]] shifts with large amounts of fluid
|-
|-
|[[Pulmonary hypertension]]
![[Pulmonary hypertension]]
|
|
*Elevated [[cardiac apex]] due to [[right ventricular hypertrophy]]
*Elevated [[cardiac apex]] due to [[right ventricular hypertrophy]]
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* Enlarged [[pulmonary arteries]]
* Enlarged [[pulmonary arteries]]
|-
|-
|[[Pneumonitis|Acute pneumonitis]]
![[Pneumonitis|Acute pneumonitis]]
|
|
*[[Bilateral]] patchy airspace opacification
*[[Bilateral]] patchy airspace opacification
|-
|-
| rowspan="2" style="background: #DCDCDC; " |[[Cardiac|Cardiac involvement]]
| rowspan="2" style="background: #DCDCDC; " |[[Cardiac|Cardiac involvement]]
|[[Cardiomegaly]]
![[Cardiomegaly]]
|
|
*[[Cardiac enlargement]]
*[[Cardiac enlargement]]
|-
|-
|[[Mitral stenosis]]
![[Mitral stenosis]]
|
|
*[[Cardiomegaly]] with [[Widened mediastinum|widening the heart shadow]]
*[[Cardiomegaly]] with [[Widened mediastinum|widening the heart shadow]]
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|-
|-
| rowspan="2" style="background: #DCDCDC; " |[[Musculoskeletal system|Musculoskeletal]] involvement
| rowspan="2" style="background: #DCDCDC; " |[[Musculoskeletal system|Musculoskeletal]] involvement
|[[Arthritis]]
![[Arthritis]]
|
|
*Soft tissue swelling of the involved joints
*Soft tissue swelling of the involved joints
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*[[Hallux valgus]]
*[[Hallux valgus]]
|-
|-
|[[Osteoporosis]]
![[Osteoporosis]]
|
|
*Periarticular [[osteoporosis]]
*Periarticular [[osteoporosis]]
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|-
|-
| rowspan="2" style="background: #DCDCDC; " |[[Gastrointestinal]] system
| rowspan="2" style="background: #DCDCDC; " |[[Gastrointestinal]] system
|[[Intestinal pseudo-obstruction]]
![[Intestinal pseudo-obstruction]]
|
|
*Dilated [[bowel]] loops with or without the presence of fluid levels
*Dilated [[bowel]] loops with or without the presence of fluid levels
*Erect [[chest]] radiographs for [[perforation]] evaluating
*Erect [[chest]] radiographs for [[perforation]] evaluating
|-
|-
|[[Autosplenectomy]]
![[Autosplenectomy]]
|
|
* Calcified [[spleen]] may be visible in the left upper quadrant
* Calcified [[spleen]] may be visible in the left upper quadrant
|-
|-
| rowspan="4" style="background: #DCDCDC; " |[[Pulmonary]] involvement
| rowspan="4" style="background: #DCDCDC; " |[[Pulmonary]] involvement
|[[Respiratory failure|Respiratory muscle dysfunction]]<ref name="pmid11571369">{{cite journal |vauthors=Rockall AG, Rickards D, Shaw PJ |title=Imaging of the pulmonary manifestations of systemic disease |journal=Postgrad Med J |volume=77 |issue=912 |pages=621–38 |year=2001 |pmid=11571369 |pmc=1742125 |doi= |url=}}</ref>
![[Respiratory failure|Respiratory muscle dysfunction]]
|
|
*Elevated hemidiaphragms at [[CXR]]
*Elevated hemidiaphragms at [[CXR]]
*Linear [[atelectasis]] and an ill-defined juxtadiaphragmatic areas of increased opacity
*Linear [[atelectasis]] and an ill-defined juxtadiaphragmatic areas of increased opacity
|-
|-
|[[Pulmonary hemorrhage]]
![[Pulmonary hemorrhage]]
|
|
*Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
*Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
|-
|-
|[[Pulmonary emboli]]
![[Pulmonary emboli]]
|
|
*[[Fleischner sign|Fleishner sign]]: Enlarged [[pulmonary artery]]
*[[Fleischner sign|Fleishner sign]]: Enlarged [[pulmonary artery]]
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*[[Pleural effusion]]
*[[Pleural effusion]]
|-
|-
|Shrinking lung syndrome
!Shrinking lung syndrome
|
|
*Small but clear [[lungs]] with [[diaphragmatic elevation]]
*Small but clear [[lungs]] with [[diaphragmatic elevation]]
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|-
|-
| rowspan="2" style="background: #DCDCDC; " |[[Cardiac]] involvement
| rowspan="2" style="background: #DCDCDC; " |[[Cardiac]] involvement
|[[Mitral regurgitation]]
![[Mitral regurgitation]]
|
|
*[[Left atrial enlargement]]
*[[Left atrial enlargement]]
Line 124: Line 124:
*Left [[ventricular]] enlargement is also eventually present due to volume overload
*Left [[ventricular]] enlargement is also eventually present due to volume overload
|-
|-
|[[Pericardial effusion]]
![[Pericardial effusion]]
|
|
*Globular enlargement of the cardiac shadow giving a water bottle configuration
*Globular enlargement of the cardiac shadow giving a water bottle configuration
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|-
|-
| style="background: #DCDCDC; " |[[Musculoskeletal system|Musculoskeletal involvement]]
| style="background: #DCDCDC; " |[[Musculoskeletal system|Musculoskeletal involvement]]
|[[Osteonecrosis]] ([[Avascular necrosis]])
![[Osteonecrosis]] ([[Avascular necrosis]])
|
|
*Initial minor [[osteopenia]], followed by variable density
*Initial minor [[osteopenia]], followed by variable density

Revision as of 21:21, 31 July 2017

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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: thumb printing sign in the abdominal graphy, blunting of the costophrenic angle due to pleural effusion, cardiomegaly, and bone deformity.

X Ray

On X ray imaging, systemic lupus erythematosus (SLE) may be characterized by the following features, based on the organ system involvement.[1][2][3][4][5][6][7][8][9][10][11][12]

More common complications

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

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

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