CTICasesConstrictive Bronchiolitis in Rheumatoid Arthritis
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Imaging findings
Recent CT shows hyperinflated lungs with subtle but definite mosaic attenuation and small pulmonary vessels in the relatively lucent areas. Cavitary lesions are noted in the upper lobes. A chest radiograph from earlier in the year also showed overinflated lungs. An older CT from 2010 revealed the same pattern of mosaic attenuation. Expiratory CT images demonstrate definite areas of air trapping consistent with obstructive small airways disease.
Key takeaways
This patient with rheumatoid arthritis and obstructive airways disease (confirmed by PFTs) presents with imaging findings highly suggestive of constrictive bronchiolitis, a known complication of RA. The mosaic attenuation, small pulmonary vessels, and air trapping on expiration are classic findings. Pathological correlation, after discussion of the imaging, was consistent with constrictive bronchiolitis and follicular bronchiolitis.
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