Usual interstitial pneumonia in rheumatoid arthritis with possible follicular bronchiolitis

Case contributed by Dr Hani Salam

Presentation

Known case of rheumatoid arthritis with progressive dyspnea and occasional productive cough.

Patient Data

Age: 55
Gender: Male

Normal chest radiographs.

Interval development of fine reticulations at both lung bases and at the posterior costophrenic angle. The lung volume is preserved. 

Progression of the bibasilar reticulation suggestive of interstitial lung disease. There is mild reduction of lung volume as compared to previous study. 

Biapical emphasymatous changes. There is bilateral fairly symmetrical inter and intralobular septal thickening associated with scattered areas of patchy ground glass opacities. The severity of changes is more toward the lung bases and the lung periphery where there is more architectural distortion, traction bronchiactasis and honeycombing. No plural effusion is seen.

Progression of the interstitial lung changes best appreciated at the left lung base and at the posterior costophrenic angle on the lateral radiograph. The lung volume is relatively still preserved. 

Marked progression of the interstitial lung disease with reduced lung volume.  

There is progression of the usual interstitial pnuemonia pattern with more inter and intralobular septal thickening and honeycombing more severe toward the lung bases and the periphery. There is more patchy ground glass opacities especially at the lung bases and subpleurally.  Interval development of small centriloboular and peribronchial nodules, and peribronchial thickening. The findings are highly suggestive of follicular bronchiolitis in the setting of rheumatoid arthritis.

Again demonstrated advance changes of interstitial lung disease with reduced lung volume. There is now more diffuse nodular changes.

The interstitial lung disease of usual interstitial pneumoonia is more or less stable but there is marked progression of the centrilobular and peribronchovascular pulmonary ground glass nodules.

Stable interstitial lung changes with reduced lung volume however, there is marked improvement in the regard to the scattered microndoular opacities as compared to previous chest radiographs.

Case Discussion

This case reflects the natural history of usual interstitial pneumonia in a patient with rheumatoid arthritis. It also showed the manifestation of follicular bronchiolitis (probable) that might develop in the course of the disease which might complicate the picture. 

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Case information

rID: 43734
Case created: 23rd Mar 2016
Last edited: 5th Nov 2017
System: Chest
Inclusion in quiz mode: Included

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