대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Systemic lupus erythematosus (SLE)

Radiologic Findings

Chest radiograph shows reticular and peripheral linear opacities in both lungs with subtle both CPA blunting.
Chest CT shows interlobular septal thickening and patchy GGOs in both lungs with bilateral pleural and pericardial effusion.
Lab findings: Anti-dsDNA Ab(+), Anti-SS-A/Ro Ab(+), and Anti-SS-B/La Ab(+)

Brief Review

Systemic lupus erythematosus(SLE) is an autoimmune disorder characterized by inflammation, immune complex deposition, vasculitis, and vasculopathy. Over one-half of patients with SLE develop pulmonary disease, with pneumonia, pulmonary hemorrhage, and lupus pneumonitis being the most common manifestations.
Pleural effusions are the most common manifestation of SLE in the respiratory system and are bilateral in approximately 50% of patients. Acute pneumonitis which occurs in up to 12% of patients manifests as unilateral or bilateral patchy consolidation, typically in the lung bases, resulting from alveolar capillary injury leading to edema and hemorrhage. An accompanying pleural effusion is often present. Focal consolidation from acute pneumonitis may be difficult to differentiate from that due to pneumonia, and, given that infection is more common, it is imperative to exclude an infectious source with both clinical and laboratory evaluation before considering lupus pneumonitis. Pulmonary alveolar hemorrhage is a rare complication of SLE and is either immune mediated or secondary to infection or uremia. Patients are typically acutely ill with hemoptysis, fever, cough, and hypoxemia, and blood loss can be extensive. Mortality rates of 70% to 90% have been reported. At chest radiography, patchy bilateral and acinar areas of increased opacity, predominantly in the lower lungs, may be present. Interstitial abnormalities are seen in approximately 30% of patients at high-resolution CT. They include interlobular septal thickening (33%), irregular linear hyperattenuating areas (33%), and architectural distortion (22%). Such abnormalities are usually mild and focal and diffuse disease occurs in only 4% of patients. Honeycombing is uncommon.

References

1. Eun A Kim, Kyung Soo Lee, Takeshi Johkoh, Tae Sung Kim, Gee Young Suh, O Jung Kwon, Jounho Han. Interstitial lung diseases associated with collagen vascular diseases: Radiologic and histoloic findings. Radiographics 2002; 22:151-165.
2. Tasneem A. Lalani, Jeffrey P. Kanne, Gregory A. Hatfield, Phebe Chen. Imaging Findings in Systemic Lupus Erythematosus. RadioGraphics 2004; 24:1069-1086.
3. Kim JS, Lee KS, Koh E, Kim SY, Chung MP, Han J. Thoracic Involvement of Systemic Lupus Erythematosus: Clinical, Pathologic, and Radiologic Findings. J Comput Assist Tomogr.2000 Jan-Feb;24(1):9 - 18

Keywords

Pleura, Pericardium, Connective tissue diseases, SLE,