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Weekly Chest CasesArchive of Old Cases

Case No : 1041 Date 2017-10-09

  • Courtesy of Yoon Kyung Kim / Gachon University Gil Hospital
  • Age/Sex 61 / M
  • Chief ComplaintRA, Polyarthralgia, Dyspnea on exertion
  • Figure 1
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  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
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  • Figure 8

Diagnosis With Brief Discussion

Diagnosis
Rheumatoid nodules
Radiologic Findings
The initial posteroanterior chest radiograph shows no abrnoaml finding. Follow up chest radiograph obatained 10 months later shows nodular lesions in both mid lateral lung zones. On chest CT, multiple small nodules are seen along the pleura and fissure in both hemithoraces. PET/CT images show multiple mild to moderate hypermetabolic lesions in bilateral subpleural areas (SUV range 1~4). Thoracoscopic surgery revealed thickening of the visceral pleura with multiple hard whitish nodules. Pathologic diagnosis was fibrinoid necrosis surrounded by epithelioid macrophages and chronic inflammation, granuloma with central necrosis, suggestive of rheumatoid nodules.
Brief Review
Rheumatoid (necrobiotic) nodules are an uncommon manifestation of rheumatoid arthritis. They often are asymptomatic but tend to appear and disappear in conjunction with subcutaneous nodules. They range in size from a few millimeters to 5 cm or more and may be solitary or multiple and numerous. Rheumatoid nodules predominate in the lung periphery and typically are well defined. They may cavitate, having thick walls that eventually become thin with healing. Pleural effusion may be associated. The cavitary nodules in the periphery may lead to pneumothorax.
Please refer to
Case 879, Case 798,
References
Keywords
Lung, Connective tissue diseases,

No. of Applicants : 79

▶ Correct Answer : 22/79,  27.8%
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Seoul National University Hospital , Korea (South) HYOUNG IN CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - HHS , Canada S LEE
  • - Chung buk national university hospital , Korea (South) hong gwon Byun
  • - Kurashiki Central Hospital , Japan TORU KONISHI
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Seoul National University Hospital , Korea (South) YONGSUB SONG
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - Private sector , Greece VASILIOS TZILAS
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
▶ Correct Answer as Differential Diagnosis : 16/79,  20.3%
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Other , Korea (South) SEONG SU KANG
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - The Jikei university , Japan TAKU GOMI
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Other , Korea (South) HAYEON LEE
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Tashkent Medical Academy , Uzbekistan Rustam Azimovich Fayzullaev
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - University of Utah , United States AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 4/79,  5.1%
  • - Busan National University Hospital , Korea (South) ILWAN SON
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - District TB centre, kasaragod,India , India rikhy krishnan
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
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