CTICasesRheumatoid Arthritis-Associated Cystic Lung Disease
Imaging findings
Extensive cystic lung disease is present, particularly pronounced in the upper lobes. Ground glass opacities in the lower lobes may represent emerging acute respiratory distress syndrome (ARDS) or underlying chronic lung injury. Gross pathology of the explanted lungs (after transplant) showed large cysts of varying sizes and a diffusely fibrotic lung, with the upper lobes completely replaced by cysts, but without classic honeycombing or fibroelastic foci.
Key takeaways
This case illustrates an unusual and extensive cystic lung disease associated with rheumatoid arthritis, distinct from typical fibrotic interstitial lung disease. It highlights the wide spectrum of pulmonary manifestations of RA. The patient developed severe ARDS and required a lung transplant, making the assessment of underlying fibrotic changes difficult due to the confounding effects of prolonged ECMO support.
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