Air trapping secondary to obliterative bronchiolitis in rheumatoid arthritis

Case contributed by Dr Yune Kwong

Presentation

Known Rheumatoid Arthritis. Shortness of breath.

Patient Data

Age: 70 years
Gender: Female

On expiratory HRCT, there are lucent lobular areas which do not increase in attenuation on expiration, consistent with air trapping.

Case Discussion

Small airway disease is increasingly recognized in rheumatoid arthritis. Pathologically, it can take the form of obliterative (constrictive) bronchiolitis or follicular bronchiolitis. Obliterative bronchiolitis refers to destruction of bronchioles and replacement by scar tissue. Follicular bronchiolitis is characterized by lymphoid aggregates in the bronchial walls and can be associated with centrilobular nodules in addition to air trapping.

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