Intra-thoracic rheumatoid arthritis: Imaging spectrum of typical findings and treatment related complications

Abstract

Non-cardiac thoracic manifestations of rheumatoid arthritis (RA) cause significant morbidity and mortality among RA patients. Essentially all anatomic compartments in the chest can be affected including the pleura, pulmonary parenchyma, airway, and vasculature. In addition, treatment-related complications and opportunistic infections are not uncommon. Accurate diagnosis of intra-thoracic disease in an RA patient can be difficult as the radiologic findings may be nonspecific and many of these conditions may coexist. This review article serves to highlight the multitude of RA-related intra-thoracic pathological processes, emphasize differential diagnosis, diagnostic conundrums and discuss how tailoring of CT imaging and image-guided biopsy plays a key role in the management of RA-related pulmonary disease.

Rheumatoid Arthritis Related Interstitial Lung Disease: Patterns of High-resolution Computed Tomography

“…Chansakul TN, in their study, concluded that traction bronchiectasis and the extent of honeycombing (as our earlier findings illustrated in Figures 4-6) were strongly associated with morbidity and mortality [20]. RA related ILD carried a bad prognosis when they compared HRCT findings to pulmonary function tests.…”

Nódulos reumatoides pulmonares

“…Los nódulos cavitados pueden complicarse originando abscesos, neumotórax y fistula broncopleural. 1,5 Pueden calcificarse y asociarse con neumoconiosis (síndrome de Caplan). 6 La TAC de tórax es la técnica radiológica más útil para identificar y definir las características de los nódulos, morfología, densidad, tamaño y permite seguir su evolución.…”

“…Su prevalencia varía según el estudio: por radiografía torácica 1% y por TAC de tórax 20-22%. 1 Aparecen tardíamente en el curso de la enfermedad. Su presentación clínica y radiológica puede confundirse con tuberculosis, infecciones fúngicas y cáncer pulmonar.…”

Intractable pneumothorax due to rupture of subpleural rheumatoid nodules: a case report

“…Rheumatoid arthritis (RA) is the most common form of chronic inflammatory arthritis; RA can cause noncardiac thoracic complications, such as pleuritis, emphysema, pneumothorax, interstitial pneumonia, and rheumatoid nodules [ 1 ]. Noncardiac thoracic complications of RA occur in 5–20% of RA patients and account for approximately 20% of RA-associated mortality [ 2 – 4 ].…”