Erythema Nodosum

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HomeRadiologyVol. 50, No. 5 PreviousNext EditorialErythema NodosumPublished Online:May 1 1948https://doi.org/10.1148/50.5.693MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThere are numerous diseases in which the roentgen manifestations have long been observed and the clinical picture is well documented but the exact etiologic background has remained obscure in spite of repeated studies contributing to its determination. Such a disease is erythema nodosum. The pulmonary and lymph node changes have long been recognized roentgenographically and the clinical manifestations are well known to dermatologists. There has never been any real agreement, however, regarding the underlying cause. Various writers have stressed an assocation with other diseases, as observed in their experience, and in recent years the role of hypersensitivity has received considerable attention.During the earlier decades of this century, erythema nodosum was generally believed to be an unusual manifestation of tuberculosis, and according to Favour and Sosman (1) that view is still the prevailing one in Great Britain and Scandinavia, though tubercle bacilli are notably absent from the lesions. In many cases, however, clinical tuberculosis has been present in some form. Paul and Pohle (3) studied a series of 20 cases of erythema nodosum for which chest roentgenograms were available and in 12 of these observed varying degrees of mediastinal or pulmonary change. In 6 of the series there was a moderate to pronounced hilar lymph-adenopathy with evidence of tuberculosis which led the authors to regard that disease as the cause of both the erythema nodosum and the lymph node involvement.In a roentgen study of the chests of 37 adults, Kerley (2) found evidence of recent disease in 28: 17 had enlarged bronchial nodes with pulmonary changes, 8 had enlarged bronchial nodes without pulmonary changes, and 3 had pulmonary disease without node enlargement. The enlarged nodes were for the most part bilateral, while the pulmonary infiltration in half the affected cases was unilateral. The node enlargement was prominent and presented no difficulty in diagnosis except for its similarity to lymphomatoid disease. The pulmonary lesions were of several types. The commonest consisted in coarse reticular striations radiating from both hila, denser and sharper in outline than blood vessels and extending, undiminished in size, to the peripheral lung fields. In addition, there were pin-head spots similar to the nodulation of silicosis or lymphangitis carcinomatosa, probably due to lymphatic obstruction. In another type there were round or oval foci varying from 3 to 5 mm. in diameter. These were located either in a single lobe or were scattered throughout both lungs. Occasionally they coalesced to form areas of opacity 2 or 3 cm. in diameter. In some instances there were combinations of linear striae and pulmonary nodules, simulating silicosis.Favour and Sosman, in a recent comprehensive review of erythema nodosum, preface the account of their own observations in 155 cases by a critical review of the literature.Article HistoryPublished in print: May 1948 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 50, No. 5 Metrics Altmetric Score PDF download