Learning objectives
To review the most common thoracic manifestations of connective tissue diseases and the corresponding imaging patterns in high-resolution computer tomography,
using didactic schemes and iconographic examples.
Background
Connective tissue diseases (CTD) are a heterogeneous set of idiopathic or autoimmune pathologies that can affect several organs,
often manifesting in thoracic structures such as the lungs,
mediastinum,
airways and pleura
CTDs that most commonly involve the thorax are Rheumatoid Arthritis (RA),
Sistemic Lupus Erythematosus (SLE),
Progressive Systemic Sclerosis (PSS),
Polymyositis and Dermatomyositis (PM-DM) and Sjögren Syndrome (SS).
Interstitial lung disease (ILD) and pulmonary arterial hypertension are the main causes of mortality and morbidity.
It is imperative that the radiologist be able to recognize the...
Findings and procedure details
General Considerations and ILD Patterns in HRCT
Pulmonary alterations,
often ILD,
may be the first manifestations of CTD preceding other clinical and laboratorial findings,
sometimes by years.
Other radiologic findings in HRCT that are suggestive of underlying CTD include oesophageal abnormalities,
pleural and pericardial effusions and thickening,
pulmonary arterial enlargement,
and osteoarticular disease (such as glenohumeral joint involvement in RA) and mediastinal lymphadenopathy.
ILD patterns are dependant on the underlying CTD,
varying in frequency and presentation.
The most common histopathologic patterns of ILD are nonspecific...
Conclusion
Although the imaging findings in different connective tissue diseases are often varied and nonspecific,
familiarity with these changes is necessary for the radiologist to guide the multidisciplinary team to the proper interpretation,
correct and timely diagnosis of these diseases.
References
Capobianco J,
Grimberg A,
Thompson BM,
Antunes VB,
Jasinowodolinski D,
Meirelles GS.
Thoracic manifestations of collagen vascular diseases.
Radiographics.
2012;32(1):33-50.
Gladue H,
Altorok N,
Townsend W,
Mclaughlin V,
Khanna D.
Screening and diagnostic modalities for connective tissue disease-associated pulmonary arterial hypertension: a systematic review.
Semin Arthritis Rheum.
2014;43(4):536-41.
Ahuja J,
Arora D,
Kanne JP,
Henry TS,
Godwin JD.
Imaging of Pulmonary Manifestations of Connective Tissue Diseases.
Radiol Clin North Am.
2016;54(6):1015-1031.
Lynch DA.
Lung disease related to collagen vascular disease.
J Thorac Imaging.
2009;24(4):299-309.
Gladue...