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
1   Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
,
Lennart B.O. Jans
1   Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
,
Elke Vereecke
1   Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
,
Jacob L. Jaremko
2   Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, Alberta, Canada
,
Thomas Van Den Berghe
1   Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
,
Koenraad J. Mortele
1   Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
,
Nele Herregods
1   Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
,
Eva Schiettecatte
1   Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
,
Robert Gosselin
1   Department of Radiology and Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
,
Min Chen
3   Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
,
Lieve Morbée
1   Department 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.



Publication History

Article published online:
31 March 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • 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