Some patients with systemic lupus erythematosus develop a gastrointestinal vasculitis with resultant symptoms of diarrhea and pain. The final end point is ischemic bowel disease. In affected patients with acute abdominal pain, CT reveals bowel wall thickening, a target-like appearance and mesenteric vascular engorgement and haziness, findings suggesting ischemic bowel disease. In distinction from more common bowel ischemia, bowel wall thickening tends to be multifocal, varies in length, and is not confined to a single vascular field. Unless irreparable damage ensues, the changes should revert to normal after therapy. A three-phase Tc-99m–pyrophosphate scintigram appears useful in these patients; a positive scan suggests a vasculitis.
This is radiology images of the systemic lupus erythematosus resulting in severe
abdominal pain. Longitudinal (A) and transverse (B) US identifies dilated small bowel (arrows) and edematous valvulae conniventes. C: Postcontrast transverse CT likewise outlines thickened valvulae conniventes. Acute mesenteric vasculitis was diagnosed, and the patient was treated with high-dose steroids, and she recovered within a week.