Chest and Chest Wall Manifestations in Rheumatic Diseases

Cedric Lycke; Lennart B.O. Jans; Elke Vereecke; Jacob L. Jaremko; Thomas Van Den Berghe; Koenraad J. Mortele; Nele Herregods; Eva Schiettecatte; Robert Gosselin; Min Chen; Lieve Morbée

doi:10.1055/s-0045-1802663

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2025; 29(02): 167-182
DOI: 10.1055/s-0045-1802663

Review Article

Chest and Chest Wall Manifestations in Rheumatic Diseases

Cedric Lycke

¹Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

,

Lennart B.O. Jans

¹Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

,

Elke Vereecke

¹Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

,

Jacob L. Jaremko

²Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada

,

Thomas Van Den Berghe

¹Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

,

Koenraad J. Mortele

¹Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

,

Nele Herregods

¹Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

,

Eva Schiettecatte

¹Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

,

Robert Gosselin

¹Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

,

Min Chen

³Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China

,

Lieve Morbée

¹Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

› Author Affiliations

Abstract

Thoracic involvement is common in patients with rheumatic diseases, contributing to significant morbidity and mortality. Early detection and prompt treatment may prevent the establishment of irreversible changes, thus improving patients' outcomes. Imaging studies play a vital role in the early detection of chest and chest wall manifestations, especially in patients with subclinical disease. Familiarity with the frequently affected thoracic regions and their presentation on imaging is therefore essential for practicing radiologists to provide an accurate assessment of the disease burden and treatment response. This review summarizes the common and less well-known chest and chest wall imaging features of rheumatic diseases.

Keywords

imaging - interstitial lung disease - anterior chest wall - spondyloarthritis - rheumatic diseases

Full Text

References

References
1 De Zorzi E, Spagnolo P, Cocconcelli E. et al. Thoracic involvement in systemic autoimmune rheumatic diseases: pathogenesis and management. Clin Rev Allergy Immunol 2022; 63 (03) 472-489
2 Aurangabadkar GM, Aurangabadkar MY, Choudhary SS, Ali SN, Khan SM, Jadhav US. Pulmonary manifestations in rheumatological diseases. Cureus 2022; 14 (09) e29628
3 Ha Y-J, Lee YJ, Kang EH. Lung involvements in rheumatic diseases: update on the epidemiology, pathogenesis, clinical features, and treatment. BioMed Res Int 2018; 2018 (01) 6930297
4 Canella C, Schau B, Ribeiro E, Sbaffi B, Marchiori E. MRI in seronegative spondyloarthritis: imaging features and differential diagnosis in the spine and sacroiliac joints. AJR Am J Roentgenol 2013; 200 (01) 149-157
5 Rennie WJ, Jans L, Jurik AG, Sudoł-Szopińska I, Schueller-Weidekamm C, Eshed I. Anterior chest wall in axial spondyloarthritis: imaging, interpretation, and differential diagnosis. Semin Musculoskel Radiol 2018; 22 (02) 197-206
6 Lee T-H, Lee CM, Kim T-H, Lee S. Anterior chest wall involvement in spondyloarthritis patients as detected by magnetic resonance imaging: a case series and literature review. J Rheum Dis 2021; 28 (03) 159-164
7 Hermann K-GA, Baraliakos X, van der Heijde DM. et al; Assessment in SpondyloArthritis international Society (ASAS). Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group. Ann Rheum Dis 2012; 71 (08) 1278-1288
8 Morais A, Duarte AC, Fernandes MO. et al. Early detection of interstitial lung disease in rheumatic diseases: a joint statement from the Portuguese Pulmonology Society, the Portuguese Rheumatology Society, and the Portuguese Radiology and Nuclear Medicine Society. Pulmonology 2023 S2531-0437(23)00205-2
9 Gul M, Moinuddin S, Alam A, Aftab I, Shah Z, Chaudhry A. Thoracic imaging finding of rheumatic diseases. J Thorac Dis 2020; 12 (09) 5110-5118
10 Baraliakos X, Østergaard M, Lambert RG. et al. MRI lesions of the spine in patients with axial spondyloarthritis: an update of lesion definitions and validation by the ASAS MRI working group. Ann Rheum Dis 2022; 81 (09) 1243-1251
11 Chatterjee S, Perelas A, Yadav R, Kirby DF, Singh A. Viewpoint: a multidisciplinary approach to the assessment of patients with systemic sclerosis-associated interstitial lung disease. Clin Rheumatol 2023; 42 (03) 653-661
12 Lee SH, Yeo Y, Kim T-H. et al; Korean Interstitial Lung Diseases Study Group. Korean guidelines for diagnosis and management of interstitial lung diseases: part 2. Idiopathic pulmonary fibrosis. Tuberc Respir Dis (Seoul) 2019; 82 (02) 102-117
13 Raghu G, Remy-Jardin M, Richeldi L. et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med 2022; 205 (09) e18-e47
14 Chung JH, Cox CW, Montner SM. et al. CT features of the usual interstitial pneumonia pattern: differentiating connective tissue disease–associated interstitial lung disease from idiopathic pulmonary fibrosis. AJR Am J Roentgenol 2018; 210 (02) 307-313
15 Doyle TJ, Dellaripa PF. Lung manifestations in the rheumatic diseases. Chest 2017; 152 (06) 1283-1295
16 Ananthakrishnan L, Sharma N, Kanne JP. Wegener's granulomatosis in the chest: high-resolution CT findings. AJR Am J Roentgenol 2009; 192 (03) 676-682
17 Tiralongo F, Palermo M, Distefano G. et al. Cryptogenic organizing pneumonia: evolution of morphological patterns assessed by HRCT. Diagnostics (Basel) 2020; 10 (05) 262
18 Ichikado K. High-resolution computed tomography findings of acute respiratory distress syndrome, acute interstitial pneumonia, and acute exacerbation of idiopathic pulmonary fibrosis. Semin Ultrasound CT MR 2014; 35 (01) 39-46
19 Fontenot AP, Schwarz MI. Immunologic lung diseases. In: Rich RR, Shearer WT, Weyand CM, Frew AJ, Schroeder H, Fleisher TA. eds. Clinical Immunology. 3rd ed.. St. Louis, MO: Mosby; 2008: 1053-1071
20 Baharuddin H, Hanafiah M, Aflah SSS, Zim MAM, Ch'Ng SS. Asymptomatic lymphocytic interstitial pneumonia with extensive HRCT changes preceding Sjogren's syndrome. Case Rep Pulmonol 2021; 2021 (01) 6693031
21 Dalvi V, Gonzalez EB, Lovett L. Lymphocytic interstitial pneumonitis (LIP) in Sjögren's syndrome: a case report and a review of the literature. Clin Rheumatol 2007; 26 (08) 1339-1343
22 Manjunatha YC, Seith A, Kandpal H, Das CJ. Rheumatoid arthritis: spectrum of computed tomographic findings in pulmonary diseases. Curr Probl Diagn Radiol 2010; 39 (06) 235-246
23 Catarina da Silva Alfaiate A, Maria Rêgo Durão V, Seabra Patrício J, Pedrosa Silva Duarte MP. Apical fibrobullous lung disease in ankylosing spondylitis: case report and literature review. Eur Clin Respir J 2022; 9 (01) 2086359
24 Criado E, Sánchez M, Ramírez J. et al. Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics 2010; 30 (06) 1567-1586
25 Nunes H, Uzunhan Y, Gille T, Lamberto C, Valeyre D, Brillet PY. Imaging of sarcoidosis of the airways and lung parenchyma and correlation with lung function. Eur Respir J 2012; 40 (03) 750-765
26 Bailey GL, Wells AU, Desai SR. Imaging of pulmonary sarcoidosis—a review. J Clin Med 2024; 13 (03) 822
27 Groner LK, Green DB, Weisman SV. et al. Thoracic manifestations of rheumatoid arthritis. Radiographics 2021; 41 (01) 32-55
28 Park MS. Diffuse alveolar hemorrhage. Tuberc Respir Dis (Seoul) 2013; 74 (04) 151-162
29 Krause ML, Cartin-Ceba R, Specks U, Peikert T. Update on diffuse alveolar hemorrhage and pulmonary vasculitis. Immunol Allergy Clin North Am 2012; 32 (04) 587-600
30 Virdi RPS, Bashir A, Shahzad G, Iqbal J, Mejia JO. Diffuse alveolar hemorrhage: a rare life-threatening condition in systemic lupus erythematosus. Case Rep Pulmonol 2012; 2012 (01) 836017
31 Di Bartolomeo S, Alunno A, Carubbi F. Respiratory manifestations in systemic lupus erythematosus. Pharmaceuticals (Basel) 2021; 14 (03) 276
32 Thompson GE, Bourne Jr MH, Casal Moura M. et al. Pleuritis and pericarditis in antineutrophil cytoplasmic autoantibody-associated vasculitis. Chest 2021; 160 (02) 572-581
33 Yao X, Abd Hamid M, Sundaralingam A. et al. Clinical perspective and practices on pleural effusions in chronic systemic inflammatory diseases. Breathe (Sheff) 2020; 16 (04) 200203
34 Villa-Forte A, Mandell BF. Cardiovascular disorders and rheumatic disease. [in Spanish]. Rev Esp Cardiol 2011; 64 (09) 809-817
35 Xanthopoulos A, Skoularigis J. Diagnosis of acute pericarditis. E-Journal of Cardiology Practice 2017;15(15):
36 Antonopoulos AS, Vrettos A, Androulakis E. et al. Cardiac magnetic resonance imaging of pericardial diseases: a comprehensive guide. Eur Heart J Cardiovasc Imaging 2023; 24 (08) 983-998
37 Gozzi L, Cozzi D, Zantonelli G. et al. Lung involvement in pulmonary vasculitis: a radiological review. Diagnostics (Basel) 2024; 14 (13) 1416
38 Tyagi S, Safal S, Tyagi D. Aortitis and aortic aneurysm in systemic vasculitis. Indian J Thorac Cardiovasc Surg 2019; 35 (Suppl. 02) 47-56
39 Khanna S, Garikapati K, Goh DSL. et al. Coronary artery vasculitis: a review of current literature. BMC Cardiovasc Disord 2021; 21 (01) 7
40 Allam MN, Baba Ali N, Mahmoud AK. et al. Multi-modality imaging in vasculitis. Diagnostics (Basel) 2024; 14 (08) 838
41 Guggenberger KV, Bley TA. Imaging in vasculitis. Curr Rheumatol Rep 2020; 22 (08) 34
42 Le Pavec J, Humbert M, Mouthon L, Hassoun PM. Systemic sclerosis-associated pulmonary arterial hypertension. Am J Respir Crit Care Med 2010; 181 (12) 1285-1293
43 Chung L, Distler O, Hummers L, Krishnan E, Steen V. Vascular disease in systemic sclerosis. Int J Rheumatol 2010; 2010: 714172
44 Meinel K, Koestenberger M, Sallmon H, Hansmann G, Pieles GE. Echocardiography for the assessment of pulmonary hypertension and congenital heart disease in the young. Diagnostics (Basel) 2020; 11 (01) 49
45 Figueiredo AFSD, Costa JF, Matos AP, Ramalho M. Esophageal dilatation as a predictor of systemic sclerosis in patients with interstitial lung disease. Turk Thorac J 2021; 22 (03) 231-236
46 Buchanan ME, Fishman EK, Azadi JR. CT evaluation of the esophagus: the role of CT imaging and CT imaging findings in diagnosing esophageal abnormalities. Curr Probl Diagn Radiol 2023; 52 (04) 289-299
47 Komiya K, Ishii H, Umeki K. et al. Computed tomography findings of aspiration pneumonia in 53 patients. Geriatr Gerontol Int 2013; 13 (03) 580-585
48 Rotondo C, Urso L, Praino E. et al. Thoracic lymphadenopathy as possible predictor of the onset of interstitial lung disease in systemic sclerosis patients without lung involvement at baseline visit: a retrospective analysis. J Scleroderma Relat Disord 2020; 5 (03) 210-218
49 Guerrini S, Bagnacci G, Barile A. et al. Anterior chest wall non-traumatic diseases: a road map for the radiologist. Acta Biomed 2020; 91 (8-S): 43-50
50 Mader R, Baraliakos X, Eshed I. et al. Imaging of diffuse idiopathic skeletal hyperostosis (DISH). RMD Open 2020; 6 (01) e001151
51 Amrami KK. Imaging of the seronegative spondyloarthropathies. Radiol Clin North Am 2012; 50 (04) 841-854
52 Baraliakos X, Maksymowych WP. Imaging in the diagnosis and management of axial spondyloarthritis. Best Pract Res Clin Rheumatol 2016; 30 (04) 608-623
53 Willesen ST, Hadsbjerg AE, Møller JM. et al. MRI-based synthetic CT: a new method for structural damage assessment in the spine in patients with axial spondyloarthritis—a comparison with low-dose CT and radiography. Ann Rheum Dis 2024; 83 (06) 807-815
54 Verhoeven F, Guillot X, Godfrin-Valnet M, Prati C, Wendling D. Ultrasonographic evaluation of the anterior chest wall in spondyloarthritis: a prospective and controlled study. J Rheumatol 2015; 42 (01) 87-92
55 Meyers SP. MRI of Bone and Soft Tissue Tumors and Tumorlike Lesions. Stuttgart, Germany: Thieme Medical Publishers; 2008
56 Lacout A, Rousselin B, Pelage J-P. CT and MRI of spine and sacroiliac involvement in spondyloarthropathy. AJR Am J Roentgenol 2008; 191 (04) 1016-1023
57 Gensler LS. Clinical features of axial spondyloarthritis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. eds. Rheumatology. 6th ed.. St. Louis, MO: Mosby; 2015: 946-950
58 de Winter JJ, van Mens LJ, van der Heijde D, Landewé R, Baeten DL. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis Res Ther 2016; 18 (01) 196
59 Shah A, Raja N, Rennie WJ. Imaging update in spondyloarthropathy. J Clin Orthop Trauma 2021; 21: 101564
60 Bron JL, de Vries MK, Snieders MN, van der Horst-Bruinsma IE, van Royen BJ. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol 2009; 28 (08) 883-892
61 Salaffi F, Ceccarelli L, Carotti M. et al. Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: how can magnetic resonance imaging help the clinician?. Radiol Med 2021; 126 (06) 843-859
62 Prasad CB, Sankar J, Dhir V, Jain S. Trolley-track sign in ankylosing spondylitis. QJM 2023; 116 (03) 231-232
63 Ziade N, Bou Absi M, Baraliakos X. Peripheral spondyloarthritis and psoriatic arthritis sine psoriase: are we dealing with semantics or clinically meaningful differences?. RMD Open 2022; 8 (02) e002592
64 Baraliakos X, Coates LC, Braun J. The involvement of the spine in psoriatic arthritis. Clin Exp Rheumatol 2015; 33 (5, Suppl 93): S31-S35
65 Nguyen MT, Borchers A, Selmi C, Naguwa SM, Cheema G, Gershwin ME. The SAPHO syndrome. Semin Arthritis Rheum 2012; 42 (03) 254-265
66 Leone A, Cassar-Pullicino VN, Casale R, Magarelli N, Semprini A, Colosimo C. The SAPHO syndrome revisited with an emphasis on spinal manifestations. Skeletal Radiol 2015; 44 (01) 9-24
67 McGauvran AM, Kotsenas AL, Diehn FE, Wald JT, Carr CM, Morris JM. SAPHO syndrome: imaging findings of vertebral involvement. AJNR Am J Neuroradiol 2016; 37 (08) 1567-1572
68 Resnick D, Niwayama G. Radiographic and pathologic features of spinal involvement in diffuse idiopathic skeletal hyperostosis (DISH). Radiology 1976; 119 (03) 559-568
69 Kushchayev SV, Glushko T, Jarraya M. et al. ABCs of the degenerative spine. Insights Imaging 2018; 9 (02) 253-274
70 Yu M, Cao Y, Li J. et al. Anterior chest wall in SAPHO syndrome: magnetic resonance imaging findings. Arthritis Res Ther 2020; 22 (01) 216