CTICasesRheumatoid Arthritis-associated Interstitial Lung Disease (RA-ILD) with UIP Pattern and Centrilobular Holes
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Imaging findings
This patient exhibits a Usual Interstitial Pneumonia (UIP) pattern of fibrosis with honeycombing and traction bronchiectasis. Additionally, small, centrilobular holes resembling emphysema are noted, despite the patient being a never-smoker. The fibrosis progressed over time. Clinical history initially suggested Idiopathic Pulmonary Fibrosis (IPF), but subsequent questioning revealed new joint pain, and serology showed high-titer rheumatoid factor and anti-CCP.
Key takeaways
Rheumatoid Arthritis-associated Interstitial Lung Disease (RA-ILD) can present as a UIP pattern, and sometimes the interstitial lung disease may precede the overt rheumatologic symptoms. Small centrilobular holes in a non-smoker with ILD might represent follicular bronchiolitis or lymphoid aggregates rather than true emphysema, potentially serving as a clue to an underlying connective tissue disease. The presence of these small cysts can complicate the application of ATS guidelines for UIP diagnosis.
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