Systemic lupus erythematosus x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]


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 X ray, blunting of the costophrenic angle due to pleural effusion, cardiomegaly, hepatomegaly, osteoprosis, tenosinovitis, and other manifestations based on the complications.

X Ray

Findings on an X ray imaging for systemic lupus erythematosus (SLE) depends on the organ system involvement and may include the following features.[1][2][3][4][5][6][7][8][9][10][11][12]

More common findings

Organ Disease Description Preview
Gastrointestinal system Enteritis
Adapted from Radiopaedia
Pulmonary involvement Pleural effusion
Adapted from Radiopaedia
Pulmonary fibrosis
  • Diffuse increased interstitial markings
  • Reduce in lung volume
  • Pulmonary nodularity may be seen
  • Shaggy outline to the heart
    • Due to adjacenet lung fibrosis so the outline of the heart is less well delineated
  • Tracheomegaly
Adapted from Radiopaedia
Pulmonary hypertension
Adapted from Radiopaedia
Acute pneumonitis
Adapted from Radiopaedia
Cardiac involvement Cardiomegaly
Adapted from Radiopaedia
Mitral stenosis
Musculoskeletal involvement Arthritis
Adapted from Radiopaedia
Adapted from Radiopaedia

Less common findings

Organ Disease Description Preview
Gastrointestinal system Intestinal pseudo-obstruction
  • Dilated bowel loops with or without the presence of fluid levels
  • Upright chest radiographs for perforation evaluating
Adapted from Radiopaedia
  • Calcified spleen may be visible in the left upper quadrant
  • Enlargement of liver silhouette
  • Medially displaced bowel loops
Adapted from Radiopaedia
Pulmonary involvement Respiratory muscle dysfunction
  • Elevated hemidiaphragms at CXR
  • Linear atelectasis and an ill-defined juxtadiaphragmatic areas of increased opacity
Adapted from Radiopaedia
Pulmonary hemorrhage
  • Patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs
Adapted from Radiopaedia
Pulmonary emboli
Adapted from Radiopaedia
Shrinking lung syndrome
Cardiac involvement Mitral regurgitation
Adapted from Radiopaedia
Pericardial effusion
  • Globular enlargement of the cardiac shadow giving a water bottle configuration
  • Anteroposterior CXR:
    • Enlarged cardiac silhouette
  • Lateral CXR:
Adapted from Radiopaedia
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
Adapted from Radiopaedia


  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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