- REVISION: -LES -AR - ES - DM/PM - SS - AS SYSTEMIC LUPUS ERYTHEMATOUS Unusually complex autoimmune disease characterized by: The disease predominantly affects women (F:M, 10:1) aged 20–50 years.  Inflammation.  Immune complex deposition.  Vasculitis.  Vasculopathy

SYSTEMIC LUPUS ERYTHEMATOUS PLEURA PARENCHYMA PLEURAL EFFUSIONS LUPUS PNEUMONITIS PLEURITIS AND PLEURAL FIBROSIS PULMONARY INFECTION PULMONARY ALVEOLAR HEMORRHAGE FIBROSIS RADIOLOGIC MANIFESTATIONS - REVISION: -LES -AR - ES - DM/PM - SS - AS

SYSTEMIC LUPUS ERYTHEMATOUS RADIOLOGIC MANIFESTATIONS PLEURAL EFFUSIONS The most common manifestation Bilateral in approximately 50% Associated with pericarditis effusion I.PLEURA - REVISION: -LES -AR - ES - DM/PM - SS - AS

SYSTEMIC LUPUS ERYTHEMATOUS RADIOLOGIC MANIFESTATIONS II. PARENCHYMAL DISEASE LUPUS PNEUMONITIS PULMONARY ALVEOLAR HEMORRHAGE Uni or bilateral patchy consolidation typically in the lung bases resulting from alveolar capillary injury The findings at CT consist of bilateral areas of consolidation and groundglass attenuation. - REVISION: -LES -AR - ES - DM/PM - SS - AS

SYSTEMIC LUPUS ERYTHEMATOUS RADIOLOGIC MANIFESTATIONS II. PARENCHYMAL DISEASE PULMONARY INFECTION Bacterial/opportunistic pathogenesis. High prevalence of pulmonary TBC - REVISION: -LES -AR - ES - DM/PM - SS - AS < 3% Sequelae of acute pneumonitis Reticular pattern, honeycombing and subpleural thickening FIBROSIS

SYSTEMIC LUPUS ERYTHEMATOUS RADIOLOGIC MANIFESTATIONS FIG 1. THIN SECTION CT SCAN SHOWS THICKENING OF INTER/INTRALOBULAR SEPTA - REVISION: -LES -AR - ES - DM/PM - SS - AS

SYSTEMIC LUPUS ERYTHEMATOUS RADIOLOGIC MANIFESTATIONS FIG 2 THIN SECTION CT SCAN SHOWS BRONCHIECTASIS AND THICKENING OF INTERLOBULAR SEPTA - REVISION: -LES -AR - ES - DM/PM - SS - AS

SYSTEMIC LUPUS ERYTHEMATOUS RADIOLOGIC MANIFESTATIONS FIG 3 HIGH RESOLUTION CT SCANS SHOW PATCHY GROUND-GLASS ATTENUATION BILATERALLY AND AIRSPACE CONSOLIDATION IN UPPER LOBES: LUPUS PNEUMONITIS - REVISION: -LES -AR - ES - DM/PM - SS - AS

RHEUMATOID ARTHRITIS Is an autoimmune disease of unknown pathogenesis that affects 1% of the population with predilection for women, characterized by inflammatory arthritis of multiple joins and produce a wide variety of intrathoracic lesions. - REVISION: -LES -AR - ES - DM/PM - SS - AS

RHEUMATOID ARTHRITIS PLEURA PARENCHYMA PLEURA DISEASE PULMONARY NODULES PLEURAL THICKENINIG OBLITERATIVE BRONCHIOLITIS PLEURAL EFFUSIONS ORGANIZING PNEUMONIA FOLLICULAR BRONCHIOLITIS NON SPECIFIC INTERSTITIAL PNEUMONIA PULMONARY FIBROSIS HONEYCOMBING AND VOLUME LOSS. RADIOLOGIC MANIFESTATIONS - REVISION: -LES -AR - ES - DM/PM - SS - AS

RADIOLOGIC MANIFESTATIONS I.PLEURA RHEUMATOID ARTHRITIS PLEURAL DISEASE: most common thoracic manifestation PLEURAL EFFUSIONS: unilateral and may be loculated - REVISION: -LES -AR - ES - DM/PM - SS - AS

RADIOLOGIC MANIFESTATIONS RHEUMATOID ARTHRITIS II. PARENCHYMAL DISEASE PULMONARY NODULES: uncommon and usually associated with advanced disease and subcutaneous nodules.Usually multiple and well circumscribed, they often result in thick walled cavities OBLITERATIVE BRONCHIOLITIS: mosaic perfusion with bronchial dilatation - REVISION: -LES -AR - ES - DM/PM - SS - AS

RADIOLOGIC MANIFESTATIONS RHEUMATOID ARTHRITIS II. PARENCHYMAL DISEASE ORGANIZING PNEUMONIA: patchy and multiple airspace consolidation usually with subpleural or peribronchial distribution FOLLICULAR BRONCHIOLITIS: centrilobular and/or peribronchial nodules and branching linear structures PULMONARY FIBROSIS: reticular or reticulonodular pattern and irregular septal thickening involving the lower lung zones. In rares cases fibrosis may be limited to upper lobes and contain areas of cavitation. Patients with fibrosis have an increased prevalence of lung cancer (adenocarcinoma). Interstitial lung changes are frequent and independent of disease duration and are more frequent and severe in rheumatoid factor positive patients and in patients with more severe joint involvement. - REVISION: -LES -AR - ES - DM/PM - SS - AS

RADIOLOGIC MANIFESTATIONS RHEUMATOID ARTHRITIS FIG 4 THICKENING OF INTERLOBULAR SEPTA - REVISION: -LES -AR - ES - DM/PM - SS - AS

RADIOLOGIC MANIFESTATIONS RHEUMATOID ARTHRITIS FIG 5: BRONCHIECTASIS WITH VOLUME LOSS - REVISION: -LES -AR - ES - DM/PM - SS - AS

RADIOLOGIC MANIFESTATIONS RHEUMATOID ARTHRITIS FIG 6:HONEYCOMBING AND BRONCHIECTASIS - REVISION: -LES -AR - ES - DM/PM - SS - AS

RADIOLOGIC MANIFESTATIONS RHEUMATOID ARTHRITIS FIG 7:PULMONARY NODULES - REVISION: -LES -AR - ES - DM/PM - SS - AS

RHEUMATOID ARTHRITIS FIG 8: HIGH- RESOLUTION CT SCANS SHOWS MOSAIC PERFUSION ON INSPIRATION (up) CT SCANS AND AIR TRAPPING ON EXPIRATORY CT(down): BRONCHIOLITIS OBLITERANS - REVISION: -LES -AR - ES - DM/PM - SS - AS

PROGRESSIVE SYSTEMIC SCLEROSIS Is a connective-tissue disease of unknown pathogenesis characterized by deposition of excessive extracellular matrix and vascular obliteration which leads to fibrosis of the lungs, skin, vasculature, and visceral organs. Two-thirds of patients with progressive systemic sclerosis have clinical pulmonary symptoms, the most common of which are dyspnea and dry, nonproductive cough. Pulmonary involvement is more common and more severe in systemic sclerosis than in other types of collagen vascular disease. - REVISION: -LES -AR - ES - DM/PM - SS - AS

PROGRESSIVE SYSTEMIC SCLEROSIS RADIOLOGIC MANIFESTATIONS PULMONARY FIBROSIS : Involve mainly the lower lobes and have a predominantly peripheral and posterior distribution. Appears initially as a fine reticular pattern that progresses to coarse reticulation and honeycombing. There is an increased prevalence of lung cancer in patients with progressive systemic sclerosis, particularly in those with pulmonary fibrosis. NONSPECIFIC INTERSTITIAL PNEUMONITIS PLEURAL DISEASE : is not a common manifestation OTHER ABNORMALITIES : areas of ground-glass attenuation, poorly defined subpleural nodules, reticular pattern of attenuation, honeycombing, and traction bronchiectasias ( lower-lobe and peripheral predominance). - REVISION: -LES -AR - ES - DM/PM - SS - AS

PROGRESSIVE SYSTEMIC SCLEROSIS RADIOLOGIC MANIFESTATIONS FIG 9: THICKENING OF INTERLOBULAR SEPTA AND BRANCHING LINEAR STRUCTURES (ARROW) - REVISION: -LES -AR - ES - DM/PM - SS - AS

PROGRESSIVE SYSTEMIC SCLEROSIS RADIOLOGIC MANIFESTATIONS FIG 10: THICKENING OF INTERLOBULAR SEPTA AND BRANCHING LINEAR STRUCTURES (ARROW) - REVISION: -LES -AR - ES - DM/PM - SS - AS

PROGRESSIVE SYSTEMIC SCLEROSIS RADIOLOGIC MANIFESTATIONS FIG 11:DIFFUSE HONEYCOMBING AT THE LUNG BASES - REVISION: -LES -AR - ES - DM/PM - SS - AS

PROGRESSIVE SYSTEMIC SCLEROSIS RADIOLOGIC MANIFESTATIONS FIG 12:THICKENING OF INTERLOBULAR SEPTA AND TRACTION BRONCHIECTASIS - REVISION: -LES -AR - ES - DM/PM - SS - AS

POLYMYOSITIS AND DERMATOMYOSITIS They are an autoimmune inflammatory myopathy characterized by symmetric weakness of the limb girdle and anterior neck muscles. Polymyositis and dermatomyositis have an incidence of approximately 5–10 cases per million per year and occur twice as often in women as in men. The thorax is commonly affected, generally in one or more of three forms: (a) hypoventilation and respiratory failure as a result of involvement of the respiratory muscles (b) interstitial pneumonitis, usually with a histologic pattern of usualinterstitial pneumonia or nonspecific interstitial pneumonia. (c) aspiration pneumonia secondary to pharyngeal muscle weakness (probably the most common pulmonary complication) - REVISION: -LES -AR - ES - DM/PM - SS - AS

POLYMYOSITIS AND DERMATOMYOSITIS RADIOLOGIC MANIFESTATIONS LINEAR ABNORMALITIES AND AREAS OF GROUND- GLASS ATTENUATION. BRONCHIOLITIS OBLITERANS ORGANIZING PNEUMONIA INTERSTITIAL FIBROSIS fine reticular pattern that progress to a coarse reticulonodular pattern and honeycombing. The lung bases are most severely involved OTHER ABNORMALITIES. - REVISION: -LES -AR - ES - DM/PM - SS - AS

POLYMYOSITIS AND DERMATOMYOSITIS RADIOLOGIC MANIFESTATIONS FIG 13: GROUND-GLASS ATENUATION - REVISION: -LES -AR - ES - DM/PM - SS - AS

POLYMYOSITIS AND DERMATOMYOSITIS RADIOLOGIC MANIFESTATIONS FIG 14:TRACTION BRONCHIECTASIS AND RETICULAR PATTERN WITH HONEYCOMBING - REVISION: -LES -AR - ES - DM/PM - SS - AS

POLYMYOSITIS AND DERMATOMYOSITIS RADIOLOGIC MANIFESTATIONS FIG 15:HIGH-RESOLUTION CT SCANS SHOWS MOSAIC PERFUSION ON INSPIRATION CT SCANS AND AIR TRAPPING ON EXPIRATORY CT: BRONCHIOLITIS OBLITERANS - REVISION: -LES -AR - ES - DM/PM - SS - AS

SJÖGREN SYNDROME Is characterized by a clinical triad of dry eyes (keratoconjunctivitis sicca), dry mouth (xerostomia), and arthritis. It is relatively common, affecting 0.1% of the general population and 3% of older adults (42). It may be primary, without features of other collagen vascular disease, or secondary in association with other collagen vascular disease, most often rheumatoid arthritis. - REVISION: -LES -AR - ES - DM/PM - SS - AS

SJÖGREN SYNDROME RADIOLOGIC MANIFESTATIONS PULMONARY FIBROSIS RETICULONODULAR PATTERN THAT INVOLVES MAINLY THE LOWER LUNG ZONES LYMPHOCYTIC INTERSTITIAL PNEUMONIA HONEYCOMBING ALONE OR BOTH HONEYCOMBING AND GROUND-GLASS ATTENUATION SUGGESTIVE OF PULMONARY FIBROSIS - REVISION: -LES -AR - ES - DM/PM - SS - AS

SJÖGREN SYNDROME FIG 16:HIGH-RESOLUTION CT SCANS SHOWS GROUND GLASS ATENUATION - REVISION: -LES -AR - ES - DM/PM - SS - AS

SJÖGREN SYNDROME FIG 17: HONEYCOMBING SUGESTIVE OF PULMONARY FIBROSIS - REVISION: -LES -AR - ES - DM/PM - SS - AS

ANKYLOSING SPONDYLITIS Is an autoimmune disease of unknown pathogenesis that primarily affects the joints of the axial skeleton. In approximately 1- 2% of patients pleuropulmonary complications develop - REVISION: -LES -AR - ES - DM/PM - SS - AS

ANKYLOSING SPONDYLITIS RADIOLOGIC MANIFESTATIONS APICAL FIBROSIS PARASEPTAL EMPHYSEMA BRONCHIECTASIAS,BRONCHIOLITIS INTERSTITIAL PNEUMONITIS - REVISION: -LES -AR - ES - DM/PM - SS - AS

ANKYLOSING SPONDYLITIS FIG 18: APICAL FIBROSIS - REVISION: -LES -AR - ES - DM/PM - SS - AS

ANKYLOSING SPONDYLITIS FIG 18: BRONCHIECTASIS RLL - REVISION: -LES -AR - ES - DM/PM - SS - AS