Thoracic imaging finding of rheumatic diseases

Abstract

In the era of Precision Medicine, diagnostic imaging plays a key role in initial diagnosis and treatment response assessment in thoracic manifestation of various rheumatic disorders; resulting in increased dependency on imaging for treatment planning. Chest radiographs serve as a good initial screening tool for assessment of emergent and urgent thoracic conditions, e.g., pneumothorax, pulmonary edema, consolidation and pleural effusions. Cross-sectional imaging techniques, e.g., computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) are most commonly utilized to evaluate more detailed pulmonary and mediastinal manifestations of rheumatic conditions. Magnetic resonance imaging (MRI) and ultrasound are most commonly used in cardiovascular, neural and musculoskeletal structures. This review article aims to highly key common thoracic imaging findings of rheumatic disorders, highlighting imaging test of choice for the particular disorder.

Keywords: Rheumatology; giant cell arteritis (GCA); granulomatosis with polyangiitis (GPA); microscopic polyangiitis (MPA); radiology; rheumatoid arthritis; sarcoidosis.

Figure 1

Sagittal (A) and coronal (B) PET-CT images of the thorax demonstrate multichamber cardiomegaly and heterogeneous myocardial wall thickening with corresponding increased FDG uptake. These findings are consistent with cardiac sarcoidosis and were confirmed on biopsy.

Figure 2

CT chest in 82 years old female with history of sinusitis, shortness of breath and hematuria shows a 15 mm nodule in the right upper lobe. Biopsy findings were consistent with GPA.

Figure 3

A 54 years old male with history of long standing untreated RA presents with shortness of breath. CT chest shows a pleural based nodule in the lingual and a pleural effusion. Biopsy of the nodule was consistent with rheumatoid necrobiotic nodule.

Figure 4

A 58 years old male with history of SLE presents with acute on chronic shortness of breath. CT chest shows multifocal areas of ground-glass opacities in bilateral lower lobes with mild linear interlobular septal thickening, which are suggestive of acute pneumonitis. The posterolateral mosaic appearance of the lungs with reticulations and mild traction bronchiectasis are consistent with fibrotic disease. Overall, imaging findings are consistent with acute on chronic pulmonary SLE.

Figure 5

CT chest in a 49 years old male with acute on chronic shortness of breath shows asymmetric multifocal lower lobe predominant interstitial thickening with traction bronchiectasis and scattered ground glass opacities. These imaging findings are consistent with scleroderma related interstitial lung disease with stigmata of fibrosis.