Thoracic Manifestations of Systemic Autoimmune Diseases: Radiographic and High-Resolution CT Findings1
Jennifer P. Mayberry, MD,
Steven L. Primack, MD and
Nestor L. Müller, MD, PhD
1 From the Department of Radiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Mail Code L340, Portland, OR 97201 (J.P.M., S.L.P.); and the Department of Radiology, University of British Columbia and Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada (N.L.M.). Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received February 21, 2000; revision requested March 31 and received May 3; accepted May 4. Address correspondence to S.L.P. (e-mail: primacks@ohsu.edu).
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Figure 1. Systemic lupus erythematosus with pleural involvement. CT scan shows pleural effusion of the left lung, as well as pericardial effusion.
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Figure 2a. Systemic lupus erythematosus with an opportunistic infection. High-resolution CT scans show patchy ground-glass attenuation bilaterally and a cavitary nodule in the superior segment of the right lower lobe (a) and focal consolidation in the left lower lobe with multiple areas of cavitation (b). Results of bronchoscopic lavage and biopsy were positive for cytomegalovirus and aspergillosis.
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Figure 2b. Systemic lupus erythematosus with an opportunistic infection. High-resolution CT scans show patchy ground-glass attenuation bilaterally and a cavitary nodule in the superior segment of the right lower lobe (a) and focal consolidation in the left lower lobe with multiple areas of cavitation (b). Results of bronchoscopic lavage and biopsy were positive for cytomegalovirus and aspergillosis.
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Figure 3. Systemic lupus erythematosus with lupus pneumonitis. Posteroanterior radiograph shows patchy bilateral areas of air-space consolidation.
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Figure 4. Systemic lupus erythematosus with tumoral calcinosis. Posteroanterior radiograph of a patient with systemic lupus erythematosus and renal failure shows a large amorphous soft-tissue calcification projecting into the right supraclavicular region and right axilla.
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Systemic lupus erythematosus with diaphragmatic dysfunction. Posteroanterior radiograph shows decreased lung volumes related to diaphragmatic dysfunction and bibasilar atelectasis.
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Figure 6. Rheumatoid arthritis with pleural effusion. CT scan shows a loculated left pleural effusion.
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Figure 7. Rheumatoid arthritis with pulmonary fibrosis. High-resolution CT scan shows honeycombing and reticulation predominantly in the lung periphery.
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Figure 8. Rheumatoid arthritis with pulmonary fibrosis and lung cancer. Posteroanterior radiograph shows bilateral peripheral areas of coarse reticulation and an irregular lung mass in the left upper lobe. The diagnosis of lung cancer was proved at surgery.
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Figure 9. Rheumatoid arthritis with thoracic bone changes. Posteroanterior radiograph shows resorption of the distal clavicles and humeral heads.
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Figure 10a. Rheumatoid arthritis with obliterative bronchiolitis in a patient who had undergone penicillamine therapy. (a) High-resolution CT scan obtained at end-inspiration shows cylindrical bronchiectasis in the right middle lobe (arrow). (b) High-resolution CT scan obtained at end-expiration shows patchy air trapping bilaterally, particularly in the right middle lobe and right lower lobe posteriorly (arrows).
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Figure 10b. Rheumatoid arthritis with obliterative bronchiolitis in a patient who had undergone penicillamine therapy. (a) High-resolution CT scan obtained at end-inspiration shows cylindrical bronchiectasis in the right middle lobe (arrow). (b) High-resolution CT scan obtained at end-expiration shows patchy air trapping bilaterally, particularly in the right middle lobe and right lower lobe posteriorly (arrows).
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Figure 11a. Scleroderma with pulmonary fibrosis. (a) Posteroanterior radiograph shows low lung volumes and bibasilar, coarse reticular markings. (b, c) High-resolution CT scans show patchy areas of peripheral honeycombing (b) and diffuse honeycombing at the lung bases (c).
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Figure 11b. Scleroderma with pulmonary fibrosis. (a) Posteroanterior radiograph shows low lung volumes and bibasilar, coarse reticular markings. (b, c) High-resolution CT scans show patchy areas of peripheral honeycombing (b) and diffuse honeycombing at the lung bases (c).
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Figure 11c. Scleroderma with pulmonary fibrosis. (a) Posteroanterior radiograph shows low lung volumes and bibasilar, coarse reticular markings. (b, c) High-resolution CT scans show patchy areas of peripheral honeycombing (b) and diffuse honeycombing at the lung bases (c).
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Figure 12. Scleroderma with nonspecific interstitial pneumonitis. High-resolution CT scan obtained through the lung bases shows bibasilar areas of consolidation. Video-assisted thoracoscopic surgical biopsy showed nonspecific interstitial pneumonitis.
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Figure 13a. Scleroderma with aspiration pneumonia. (a) High-resolution CT scan shows air-space consolidation in the superior segments of both lower lobes. (b) High-resolution CT scan (mediastinal windows) shows a dilated, fluid-filled esophagus.
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Figure 13b. Scleroderma with aspiration pneumonia. (a) High-resolution CT scan shows air-space consolidation in the superior segments of both lower lobes. (b) High-resolution CT scan (mediastinal windows) shows a dilated, fluid-filled esophagus.
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Figure 14. Polymyositis with pulmonary fibrosis (usual interstitial pneumonia). High-resolution CT scan shows peripheral architectural distortion and bilateral traction bronchiectasis.
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Figure 15a. Dermatomyositis with bronchiolitis obliterans organizing pneumonia. High-resolution CT scans show a peripheral area of consolidation in the right middle lobe (a) and peribronchial consolidation in both lung bases (b).
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Figure 15b. Dermatomyositis with bronchiolitis obliterans organizing pneumonia. High-resolution CT scans show a peripheral area of consolidation in the right middle lobe (a) and peribronchial consolidation in both lung bases (b).
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Figure 16. Sjögren syndrome with bronchiectasis. High-resolution CT scan shows extensive bilateral cylindrical bronchiectasis.
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Figure 17. Sjögren syndrome with lymphocytic interstitial pneumonitis. High-resolution CT scan shows scattered bilateral thin-walled cysts.
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Figure 18a. Ankylosing spondylitis. (a) Posteroanterior radiograph shows severe bilateral scarring in the upper lobes and volume loss. (b) Lateral radiograph shows flowing syndesmophytes of the thoracic spine. (c) CT scan shows severe volume loss of the lung apices with traction cystic bronchiectasis.
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Figure 18b. Ankylosing spondylitis. (a) Posteroanterior radiograph shows severe bilateral scarring in the upper lobes and volume loss. (b) Lateral radiograph shows flowing syndesmophytes of the thoracic spine. (c) CT scan shows severe volume loss of the lung apices with traction cystic bronchiectasis.
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Figure 18c. Ankylosing spondylitis. (a) Posteroanterior radiograph shows severe bilateral scarring in the upper lobes and volume loss. (b) Lateral radiograph shows flowing syndesmophytes of the thoracic spine. (c) CT scan shows severe volume loss of the lung apices with traction cystic bronchiectasis.
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Figure 19a. Wegener granulomatosis. (a) Posteroanterior radiograph shows bilateral irregular nodules and a mass in the right lower lobe. (b) High-resolution CT scan shows multiple irregular nodules in a peribronchovascular distribution.
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Figure 19b. Wegener granulomatosis. (a) Posteroanterior radiograph shows bilateral irregular nodules and a mass in the right lower lobe. (b) High-resolution CT scan shows multiple irregular nodules in a peribronchovascular distribution.
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Figure 20. Wegener granulomatosis with tracheal involvement. CT scan shows diffuse thickening of the tracheal wall.
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Figure 21a. Churg-Strauss syndrome. (a) Posteroanterior radiograph shows patchy bilateral areas of consolidation predominantly in the right lung. (b) High-resolution CT scan shows patchy bilateral ground-glass attenuation and consolidation of the right lower lobe.
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Figure 21b. Churg-Strauss syndrome. (a) Posteroanterior radiograph shows patchy bilateral areas of consolidation predominantly in the right lung. (b) High-resolution CT scan shows patchy bilateral ground-glass attenuation and consolidation of the right lower lobe.
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Figure 22. Anti-glomerular basement membrane antibody disease. Posteroanterior radiograph shows bilateral perihilar air-space consolidation.
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Copyright © 2000 by the Radiological Society of North America.
