Learning Radiology xray montage
 
 
 
 
 
 

Lupus Erythematosis

  • Lungs and pleura are involved more often in lupus than any other collagen vascular disease (type III immune complex phenomenon)

  • Findings include:

    • Anti-nuclear antibody present in 87%

    • LE cells in 78%

    • Hypergammaglobulinemia in 77%

    • Rheumatoid factor in 21%

  • Skin changes include

    • Butterfly rash

    • Alopecia

    • Photosensitivity

    • Raynaud's

  • Can be induced by drugs

    • Four drugs account for 90% of cases

      • Hydralazine

      • Pronestyl (procainamide)

      • Dilantin

      • INH

    • Pleuroparenchymal changes more common than SLE

    • This form does not involve kidney and will disappear if drug is stopped

Imaging 

  • Patchy areas of consolidation at the lung bases, especially peripherally

  • These may be 2° to infection (common) or lupus infiltrates (uncommon)

  • Pleural effusion is probably most common lung manifestation 2° pleuritis

  • Usually bilateral and small but may become very large

  • If unilateral, more often on the left

  • Discoid atelectasis is common

  • Massive pulmonary hemorrhage may occur

  • Cavitary nodules may occur (but are more common in RA)

  • Cardiomegaly may be 2° to effusion or cardiomyopathy

  • Diffuse interstitial fibrosis does not occur in SLE

Think of SLE with combination of:

  •  Pleural effusion, discoid atelectasis and patchy infiltrates at the bases (DDx: thromboembolic disease)