Air trapping secondary to obliterative bronchiolitis in rheumatoid arthritis
Known Rheumatoid Arthritis. Shortness of breath.
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On expiratory HRCT, there are lucent lobular areas which do not increase in attenuation on expiration, consistent with air trapping.
Small airway disease is increasingly recognised 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 characterised by lymphoid aggregates in the bronchial walls and can be associated with centrilobular nodules in addition to air trapping.