Jolles H, Moseley P L, Peterson M W
Department of Radiology, Medical College of Virginia, Richmond.
Chest. 1989 Nov;96(5):1022-5. doi: 10.1378/chest.96.5.1022.
Nodular opacities are a well-known pulmonary manifestation of rheumatoid arthritis (RA), occurring most often in seropositive men who smoke and have subcutaneous nodules. In the past 15 years two cases of lung carcinoma presenting as pulmonary nodules have been reported in patients with rheumatoid disease. We present seven patients with seropositive RA and subcutaneous nodules who had new pulmonary nodule(s) noted on chest roentgenograms. All but one were current smokers. Carcinoma was found in all patients at bronchoscopy or thoracotomy. Four patients had solitary nodules (one was cavitary); the remaining three patients had multiple bilateral nodules that cavitated in one case. All patients had interstitial abnormality (peribronchial/vascular thickening) with basal predominance in three, and there was evidence of pleural thickening/fluid in three patients. These results strongly suggest that histologic proof of presumed rheumatoid pulmonary nodules be obtained.
结节状阴影是类风湿关节炎（RA）一种众所周知的肺部表现，最常出现在血清学阳性、吸烟且有皮下结节的男性患者中。在过去15年里，已有两例类风湿病患者出现表现为肺结节的肺癌的报道。我们报告了7例血清学阳性的RA且有皮下结节的患者，他们在胸部X线片上发现了新的肺结节。除1例患者外，其余均为现吸烟者。所有患者在支气管镜检查或开胸手术时均发现有癌症。4例患者有孤立性结节（1例有空洞）；其余3例患者有双侧多发结节，其中1例出现空洞。所有患者均有间质异常（支气管周围/血管增厚），3例以基底为主，3例有胸膜增厚/胸腔积液的证据。这些结果强烈提示，应对疑似类风湿性肺结节进行组织学证实。
