Jones J S
Br J Dis Chest. 1978 Jan;72(1):39-56. doi: 10.1016/0007-0971(78)90006-2.
Nine case histories and references to published reports are used to illustrate the manifestations and management of pleural effusions, lung nodules and lung cavities which may occur in cases of rheumatoid disease. Repeated aspiration of effusions seldom is useful. They often are chronic and symptomless. What is taking place in some turbid and purulent effusions is debatable, since there can be an associated leucocytosis without infection. In the presence of acute symptoms, such as rigors, careful evaluation of such effusions is required, since there have been fatal examples with rather uncertain bacteriological findings. Lung nodules ordinarily cause a radiographic blemish without symptoms but may predispose to small haemoptyses or may rupture into the pleural cavity to cause a pneumothorax, usually requiring surgical resection of the nodule, whether or not a pleural effusion is present. Some nodules and lung cavities do not have the histology of the typical necrobiotic nodule but it is unlikely that they are fundamentally different. Large cavitated lung lesions which closed on azothioprine treatment are described, together with similar untreated cavities which became secondarily infected with a fatal outcome. It is suggested that the history of possible rheumatoid disease, even of 'aches and pains' must be sought if this aetiology for pleural effusions, lung nodules and unusual lung cavities is not to be overlooked, with the penalty of diagnostic thoracotomy or wrong treatment for the patient.
本文通过九个病例史以及对已发表报告的引用，阐述了类风湿病患者可能出现的胸腔积液、肺结节和肺空洞的表现及处理方法。反复抽吸胸腔积液很少有用。这些积液通常是慢性且无症状的。一些浑浊脓性胸腔积液的情况存在争议，因为可能出现伴有白细胞增多但无感染的情况。在出现寒战等急性症状时，需要对这类胸腔积液进行仔细评估，因为曾有细菌学检查结果不明确但导致死亡的病例。肺结节通常在影像学上表现为瑕疵且无症状，但可能引发小咯血，或破裂进入胸腔导致气胸，通常需要手术切除结节，无论是否存在胸腔积液。一些结节和肺空洞没有典型坏死性结节的组织学特征，但它们在本质上不太可能有差异。文中描述了在硫唑嘌呤治疗下闭合的大的肺空洞性病变，以及类似的未经治疗而继发感染并导致致命后果的空洞。文章指出，如果不想因忽视胸腔积液、肺结节和不寻常肺空洞的这种病因，而让患者面临诊断性开胸手术或错误治疗的风险，就必须询问患者是否有可能患类风湿病的病史，哪怕只是“疼痛”。
