Systemic lupus erythematosus x ray

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

Overview

X Ray

Shrinking lung (radiograph):  unexplained dyspnoea. restrictive pattern onpulmonary function tests.

Chest x-ray often shows small but clear lungs with diaphragmatic elevation. Occasional basal atelectasis may be present. 

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
Organ Disease Description
Gastrointestinal system Dysphagia
  • Barium swallow / esophagography
    • Oesophageal stricture
      • Peptic strictures that appear as smooth, tapered narrowing in the distal esophagus
    • 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
  • 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
Respiratory muscle dysfunction
  • Elevated hemidiaphragms at CXR
  • Linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity

PMC1742125

Acute pneumonitis
  • bilateral patchy airspace opacification
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 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
  • 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 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)
  • 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
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

References

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