DOI: 10.1148/rg.244985082
Imaging Findings in Systemic Lupus Erythematosus1
Tasneem A. Lalani, MD,
Jeffrey P. Kanne, MD,
Gregory A. Hatfield, MD, MSE and
Phebe Chen, MD
1 From the Department of Radiology, University of Washington Medical Center, University of Washington School of Medicine, 1959 NE Pacific, Box 357115, Seattle, WA 98195-7115 (T.A.L., J.P.K.); Suburban Radiologic Consultants, Minneapolis, Minn (G.A.H.); and the Department of Radiology, University of Texas Health Sciences Center at Houston, Houston, Tex (P.C.). Presented as an education exhibit at the 1997 RSNA scientific assembly. Received April 15, 1998; revision requested May 1, 1998 and final revision received November 25, 2003; accepted November 26. All authors have no financial relationships to disclose. Address correspondence to T.A.L. (e-mail: tal99@u.washington.edu).
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Figure 1. Massive retroperitoneal hemorrhage due to thrombocytopenia in a 21-year-old woman with SLE and aPL-ab syndrome. Contrast material-enhanced computed tomographic (CT) scan shows a large, heterogeneous retroperitoneal fluid collection (*) that represents hemorrhage.
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Figure 2. Serositis in a 13-year-old boy with SLE. Contrast-enhanced CT scan shows bilateral pleural effusions (*), cardiomegaly, and a pericardial effusion (arrow). Bilateral lower lobe atelectasis is also present.
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Figure 3. Acute lupus pneumonitis in a 61-year-old woman. Contrast-enhanced CT scan shows a lingular area of patchy increased attenuation (arrow) and small bilateral pleural effusions.
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Figure 4. Acute pulmonary hemorrhage in a 21-year-old woman with SLE. Contrast-enhanced CT scan shows patchy ground-glass attenuation in the posterior lower lobes. Bilateral pleural effusions are also present.
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Figure 5. Acute pulmonary embolism in a 66-year-old man with SLE and aPL-ab syndrome. Pulmonary CT angiogram shows a large clot in the central right lung (arrow).
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Figure 6. M tuberculosis in a 48-year-old woman with SLE. Unenhanced CT scan shows consolidation with cavitation in the left apex.
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Figure 7. Nocardia infection in a 32-year-old woman with SLE. Contrast-enhanced CT scan demonstrates consolidation with cavitation in the right upper lobe.
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Figure 8. Complications of recurrent pulmonary infection in a 41-year-old woman with SLE. Thin-section CT scan shows bronchiectasis (arrow) and thickening of the interlobular septa (arrowhead). The heart is moderately enlarged.
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Figure 9. Lupus pericarditis in a 42-year-old woman. Contrast-enhanced CT scan demonstrates cardiomegaly, a thickened and enhancing pericardium, and a pericardial effusion.
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Figure 10a. Valve leaflet thickening in a 45-year-old woman with SLE-related endocarditis. (a) Color Doppler flow echocardiogram shows mitral regurgitation (arrow). (b) Two-dimensional echocardiogram demonstrates a thickened mitral valve leaflet (arrow). (Case courtesy of Catherine M. Otto, MD, Department of Cardiology, University of Washington, Seattle.)
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Figure 10b. Valve leaflet thickening in a 45-year-old woman with SLE-related endocarditis. (a) Color Doppler flow echocardiogram shows mitral regurgitation (arrow). (b) Two-dimensional echocardiogram demonstrates a thickened mitral valve leaflet (arrow). (Case courtesy of Catherine M. Otto, MD, Department of Cardiology, University of Washington, Seattle.)
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Figure 11. Bowel perforation in a 37-year-old woman with SLE. Contrast-enhanced CT scan shows inflammation and extraluminal gas in the upper right side of the abdomen. Necrosis and perforation were confirmed at laparotomy.
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Figure 12. Reflux esophagitis in a patient with SLE. Air-contrast esophagogram shows mucosal granularity (arrows).
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Figure 13. Acute cholecystitis in a 33-year-old woman with SLE. Contrast-enhanced CT scan shows pericholecystic fluid (arrow) and mural thickening.
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Figure 14. Acute pancreatitis in a patient with SLE. Contrast-enhanced CT scan shows edema and inflammation in the pancreatic head (arrow).
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Figure 15. Chronic pancreatitis and chronic renal failure from SLE in a 28-year-old woman. Unenhanced CT scan shows an atrophic pancreas with calcifications (arrowheads). The kidneys are also atrophic, with cortical thinning and renal sinus lipomatosis (arrows).
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Figure 16. Splenic infarctions from lupus vasculopathy in a 30-year-old woman with SLE. Contrast-enhanced CT scan demonstrates peripheral low-attenuation areas within the spleen.
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Figure 17. Hepatic infarction from aPL-ab syndrome in a 20-year-old man. Contrast-enhanced CT scan shows a wedge-shaped low-attenuation area in the liver (arrow) adjacent to the gallbladder. Similar areas were present elsewhere in the liver and proved to be infarctions at percutaneous biopsy.
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Figure 18. Lupus nephritis in a 21-year-old woman with SLE. Longitudinal US image shows mild echogenicity of the right kidney (cursors) relative to the liver. Results of percutaneous biopsy confirmed nephritis.
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Figure 19a. Renal vein thrombosis in a 27-year-old woman with SLE. (a) Contrast-enhanced CT scan shows a clot within the left renal vein (arrowheads). (b) Contrast-enhanced CT scan reveals that the clot extends into the inferior vena cava.
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Figure 19b. Renal vein thrombosis in a 27-year-old woman with SLE. (a) Contrast-enhanced CT scan shows a clot within the left renal vein (arrowheads). (b) Contrast-enhanced CT scan reveals that the clot extends into the inferior vena cava.
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Figure 20. AVN of the femoral head secondary to SLE. Anteroposterior radiograph of the pelvis shows subchondral fractures and joint surface disruption of the left femoral head.
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Figure 21a. Multiple bone infarcts in a 26-year-old woman with SLE and left knee pain. (a) Anteroposterior radiograph of the left knee shows sclerosis in the distal femur and proximal tibia. (b) Sagittal T1-weighted MR image shows foci of isointense signal encircled by a low-signal-intensity rim in the distal femur and proximal tibia (arrows). The hypointense rim represents reparative granulation tissue surrounding infarcted bone.
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Figure 21b. Multiple bone infarcts in a 26-year-old woman with SLE and left knee pain. (a) Anteroposterior radiograph of the left knee shows sclerosis in the distal femur and proximal tibia. (b) Sagittal T1-weighted MR image shows foci of isointense signal encircled by a low-signal-intensity rim in the distal femur and proximal tibia (arrows). The hypointense rim represents reparative granulation tissue surrounding infarcted bone.
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Figure 22. Insufficiency fracture in a patient with SLE. The patient presented with ankle pain but had no history of trauma. Oblique radiograph of the right ankle shows a fracture through the distal fibular diaphysis (arrow).
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Figure 23. Osteomyelitis in a patient with SLE. Anteroposterior radiograph of the distal right leg shows bone destruction and periostitis involving the lateral aspect of the tibia.
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Figure 24a. Multiple cerebral infarctions in a 52-year-old woman with SLE. (a) Unenhanced CT scan shows a low-attenuation area in the distribution of the right middle cerebral artery (arrow). (b) Unenhanced CT scan obtained 3 years later shows encephalomalacia near the right sylvian fissure from the previous infarction and a new region of low attenuation with partial effacement of the left lateral ventricle in the distribution of the left middle cerebral artery.
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Figure 24b. Multiple cerebral infarctions in a 52-year-old woman with SLE. (a) Unenhanced CT scan shows a low-attenuation area in the distribution of the right middle cerebral artery (arrow). (b) Unenhanced CT scan obtained 3 years later shows encephalomalacia near the right sylvian fissure from the previous infarction and a new region of low attenuation with partial effacement of the left lateral ventricle in the distribution of the left middle cerebral artery.
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Figure 25. Hypertensive intracranial hemorrhage in a 45-year-old woman with SLE and hypertension secondary to chronic renal failure. Unenhanced CT scan shows massive hemorrhage in the left hemisphere with substantial mass effect.
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Figure 26. SLE vasculopathy in a 55-year-old woman who presented with seizures. Unenhanced CT scan shows subarachnoid hemorrhage tracking in the sulci and basilar cisterns and along the sylvian fissures.
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Figure 27. Candida cerebral abscess in a 39-year-old woman with SLE and mitral valve endocarditis who was undergoing immunosuppressive therapy. Gadolinium-enhanced T1-weighted MR image shows a right periventricular mass with peripheral rim enhancement surrounding a low-signal-intensity area of central necrosis.
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Copyright © 2004 by the Radiological Society of North America.
