Abdominal manifestations of multisystem diseases: a pattern-based imaging review

Multisystem diseases frequently present with overlapping clinical and imaging manifestations, making diagnosis challenging and often delayed. Many of these entities involve the abdomen early in the disease course, and abdominal imaging may provide the first clue to a systemic process. A pattern-based imaging approach is therefore essential for narrowing the differential diagnosis and guiding further clinical evaluation. This review highlights the multimodality imaging features of several important multisystem inflammatory and infiltrative diseases encountered in abdominal radiology, including IgG4-related disease, Behçet disease, Erdheim-Chester disease, amyloidosis, and sarcoidosis. For each entity, key abdominal manifestations are emphasized alongside characteristic extra-abdominal imaging findings that may support the diagnosis. Imaging appearances with an emphasis on abdominal findings across computed tomography, magnetic resonance imaging, ultrasound, and ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography are discussed with attention to disease distribution, enhancement characteristics, associated systemic findings, and common mimics. Although imaging findings are often nonspecific in isolation, integration of abdominal imaging patterns with extra-abdominal features can substantially narrow the differential diagnosis. Familiarity with these characteristic imaging manifestations may improve diagnostic confidence, guide targeted biopsy, and facilitate timely multidisciplinary management.