CTICasesNecrobiotic Rheumatoid Nodules Causing Pneumothorax and Pneumomediastinum
Imaging findings
Chest radiographs and CT images demonstrate multiple slowly growing, bilateral pulmonary nodules of varying sizes. The largest nodule in the right lung is a confluent subpleural mass with prominent internal bubbles of gas and irregular, speculated borders. These cavitary nodules have necrotic centers, and one of them has ruptured, resulting in a large pneumothorax, pneumomediastinum, and extensive tracking of subcutaneous gas.
Key takeaways
Pulmonary rheumatoid necrobiotic nodules are uncommon manifestations of rheumatoid arthritis that typically occur in patients with seropositive disease. While they are usually benign and slowly progressive, their subpleural location and necrotic centers put them at risk for rupture. Ruptured nodules can create a bronchopleural fistula, leading to complications like pneumothorax, pneumomediastinum, and subcutaneous emphysema, which can be challenging to manage clinically.
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