CTICasesConstrictive Bronchiolitis in Rheumatoid Arthritis with Complicating Invasive Aspergillosis
Imaging findings
Chest radiographs showed hyperinflated lungs. CT demonstrated severe hyperinflation with mosaic attenuation and evidence of vessel dropout in dependent regions, consistent with constrictive bronchiolitis. Subsequent development of cavitated and non-cavitated lung nodules was observed.
Key takeaways
Constrictive bronchiolitis is a recognized pulmonary manifestation of rheumatoid arthritis, characterized by widespread small airway obstruction leading to air trapping, hyperinflation, and mosaic attenuation on CT. The pathological findings often include follicular bronchitis and dropout of airways. Immunosuppressive therapy for rheumatoid arthritis can predispose patients to opportunistic infections like aspergillosis, which can manifest as cavitated lung nodules. The air trapping may be uniform and widespread, making the mosaic pattern less obvious, but vessel dropout in dependent regions remains a key clue.
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