Elsevier

Clinics in Chest Medicine

Volume 19, Issue 4, 1 December 1998, Pages 573-586
Clinics in Chest Medicine

RADIOLOGIC MANIFESTATIONS OF THE SYSTEMIC AUTOIMMUNE DISEASES

https://doi.org/10.1016/S0272-5231(05)70104-0Get rights and content

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SYSTEMIC LUPUS ERYTHEMATOSUS

The majority of patients with systemic lupus erythematosus (SLE) develop pleural or pulmonary disease at some time during the course of their illness.21, 65 The most common radiographic manifestation is pleural effusion,65 which can be unilateral or bilateral and is frequently associated with pericardial effusion (Fig. 1).58 Although most pleural effusions resolve completely, some residual pleural thickening may persist.

Although pleural disease is more frequently seen, pulmonary parenchymal

RHEUMATOID ARTHRITIS

Pleural involvement is probably the most common thoracic manifestation of rheumatoid arthritis. Although pleural effusions occur, pleural thickening is a more frequently seen radiographic finding.62 Pleural disease is much more common in male patients and is usually asymptomatic.26 Pleural effusions are usually unilateral and are often loculated (Fig. 4). Although pleural effusions usually occur late in the disease, they do not correlate with severity of arthritis and may occasionally develop

SJÖGREN'S SYNDROME

Interstitial fibrosis occurs in Sjögren's syndrome and has a similar pattern and distribution as other collagen vascular diseases.29, 54 Parenchymal abnormalities consistent with interstitial fibrosis are seen on chest radiograph in 10% to 14% of cases.18, 31, 54 Patients with Sjögren's syndrome also have an increased incidence of lymphocytic interstitial pneumonitis that presents radiographically as a reticulonodular pattern involving predominantly the lower lobes.56 Patients with Sjögren's

POLYMYOSITIS/DERMATOMYOSITIS

The most common radiographic abnormality is probably aspiration pneumonia secondary to pharyngeal muscle weakness. It occurs in approximately 50% of patients.11, 49 Radiographic findings of aspiration pneumonia consist of segmental areas of air space consolidation that may be unilateral or bilateral and involve the dependent lung regions. Involvement of the diaphragm leads to diaphragmatic elevation, small lung volumes, and basilar linear atelectasis.47

Interstitial fibrosis with a pattern and

PROGRESSIVE SYSTEMIC SCLEROSIS

Pulmonary disease is common in patients with progressive systemic sclerosis (PSS, scleroderma). Interstitial fibrosis is the most common radiographic abnormality, being present in 20% to 65% of patients.3, 48 The fibrosis usually has a basilar predominance, initially presenting as a fine reticular pattern that progresses to coarse reticulation and honeycombing (Fig. 10).3 High resolution CT scanning may demonstrate evidence of fibrosis in patients with normal radiographs.23, 48 In a prospective

ANKYLOSING SPONDYLITIS

Apical fibrosis has been described as the most common pulmonary abnormality evident on the chest radiograph in patients with ankylosing spondylitis. In a study of chest radiographic findings in 2080 patients with ankylosing spondylitis, 26 (1.2%) had fibrosis in the upper lobes.45 The radiographic findings consist of reticulonodular opacities in the lung apices, which become confluent as the disease progresses.7, 45, 66 Common associated abnormalities include apical bullae and cavities (Fig. 12)

WEGENER'S GRANULOMATOSIS

Wegener's granulomatosis (WG) is a systemic autoimmune disorder characterized by necrotizing granulomatous vasculitis involving the upper and lower respiratory tracts, necrotizing glomerulonenephritis, and small vessel vasculitis. During the course of the disease, most patients have lung involvement. In a study of 158 patients with WG, the chest radiograph was abnormal at presentation in 45% of patients and eventually abnormal in 85% of patients.24 The most common radiographic findings are

CHURG-STRAUSS SYNDROME

Churg-Strauss syndrome is a systemic necrotizing vasculitis that occurs almost exclusively in patients with asthma. The chest radiograph is abnormal in the majority of patients. In one review of 138 cases, pulmonary opacities were present on chest radiographs in 74% of patients.32 The radiographic appearances are variable. The most common findings are patchy nonsegmental areas of consolidation with no zonal predominance. The abnormalities are often transient and may have a peripheral

ANTIGLOMERULAR BASEMENT MEMBRANE DISEASE

Antiglomerular basement membrane disease is defined by a triad of diffuse pulmonary hemorrhage, glomerulonephritis, and circulating antiglomerular basement membrane antibodies. The chest radiograph typically demonstrates extensive bilateral air-space consolidation5 (Fig. 18). The consolidation usually is symmetric and has a perihilar predominance with a tendency to spare the lung apices. The consolidation usually resolves within 2 to 3 days and is replaced by a reticulonodular pattern and

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    Address reprint requests to Nestor L. Müller, MD, PhD, Department of Radiology, Vancouver Hospital and Health Sciences Centre, University of British Columbia, 855 W. 12th Avenue, Vancouver, British Columbia, Canada V5Z 1M9

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