Learning objectives
To review imaging findings of the thoracic manifestations of the main immune-mediated diseases.
To refresh knowledge on relevant clinical and serological diagnostic criteria for such diseases.
Background
Immune-mediated diseases are a group of unrelated conditionswith a common inflammatory pathway.
The thoracic manifestations of these diseases are diverse.
All the compartments can be independently or simultaneously affected,
including the respiratory tract,
pleural cavity,
diaphragm,
esophagus,
all cardiac structures and musculoskeletal sites,
depending on the pathophysiologic aspects of the underlying disease process.The most relevant immune-mediated diseases that involves the chest are summarized onTable 1.
It is necessary to exclude the possibility of thoracic complications related to the drug therapy,
as well as opportunistic infections...
Findings and procedure details
Systemic Lupus Erythematosus
SLE affects people of all ages,
genders,
and ethnic groups,
occurring more frequently in young women.
Diagnosis is based on clinical features and serological autoantibodies.
The presence of any four criteria listed on Table 2 ,
with at least one in the clinical and one in the immunologic category,
qualifies the patient to have SLE.
Image findings
Pleural disease:the most common thoracic manifestation,
seen as unilateral or bilateral pleural effusion in 30–50% of patients,
often associated with pericardial effusion.
Interstitial lung disease:rare...
Conclusion
Radiologists play an important role in the evaluation of thoracic involvement in auto-immune diseases,
but imaging findings alone can be unspecific or even deceiving when not compared to clinical and serological features.
Therefore,
the radiologist’s general knowledge and the understanding of the clinical background are essential to properly direct the correct diagnosis and follow-up of these patients.
References
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2012.
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Mayberry,
Steven L.
Primack,
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Müller.
Thoracic Manifestations of Systemic Autoimmune Diseases: Radiographic and High-Resolution CT Findings.
Radiographics.
20:1623-1635,
2000.
3. Felix Woodhead,
Athol U.
Wells,
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Desai.
Pulmonary Complications of Connective Tissue Diseases.
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Isabela S.
Silva,
Nestor L.
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Intrathoracic manifestations of collagen vascular diseases on...