Chest roentgenographic changes in systemic lupus erythematosus.

Abstract

During the past eight years, 275 patients with systemic lupus erythematosus have been under the clinical supervision of one of the authors (E. L. D.). Roentgenograms of the chest were reviewed in 207 of these. In view of the variability of the reported incidence and nature of the roentgenographic changes in this disease, it was thought that a presentation of the findings and a comparison with those of others would aid in evaluation of one facet of this complex entity. Clinical Features Systemic lupus erythematosus is a chronic disease occurring predominantly in females and subject to spontaneous exacerbations and remissions. In one study, remissions were seen in almost 40 per cent of cases (1). Although occasionally a single organ system bears the brunt of this disease, the manifestations are protean and characteristically many organ systems are affected. The extent of involvement of any site and the number of organs involved are equally unpredictable. The outline below classifies the clinical manifestations and demonstrates their multiplicity. Clinical Picture of Systemic Lupus Erythematosus 1. Signs of catabolism: fever, weight loss, emaciation. 2. Connective-tissue lesions: pleurisy, pericarditis, rheumatoid arthritis. 3. Vascular lesions: skin, ocular fundi, kidney, central nervous system, gastrointestinal tract, adenopathy, splenomegaly, Raynaud's phenomenon. 4. Depression of peripheral blood elements: normocytic anemia, leukopenia, thrombocytopenia, circulating anticoagulant. The first 62 cases of the present series have been reported previously by one of the authors (2), and succeeding cases have shown no significant change in pattern or course. Of the many symptoms listed above, arthritis, cutaneous eruptions, pleurisy, and cardiac involvement are the most frequent. At the onset of the disease and with only one organ system affected, diagnosis is often impossible. This would apply when a patient exhibits atypical rheumatoid arthritis. If, however, unusual skin lesions and renal involvement develop, systemic lupus is very likely. Multiple organ involvement need not be concurrent. A patient may have healed discoid skin lesions and years later develop pleuropericarditis with or without a cutaneous relapse. The extent to which the L. E. cell test and skin biopsy contribute to diagnosis is shown in Table 1. Review of the Literature with Respect to Pleural, Pulmonary, and Cardiac Changes Before any extensive reviews of radiologic findings in the chest had been reported, Rakov and Taylor (3) in 1942 and Foldes (4) in 1946 focused attention upon pulmonary changes by reporting single cases of long standing consolidation with peculiar histopathologic features consisting of vascular involvement and disappearance or hyalinization of alveoli. This was called atelectasizing pneumonia. Sante and Wyatt (5) in 1951 stated that, in their experience, involvement of the lung proper was very uncommon except in the terminal stages of the disease.