Kimura K, Toyama K, Yoshida M, Hojyo T, Ryo H, Nakata M, Sim J
First Department of Internal Medicine, School of Medicine, Toho University, Tokyo, Japan.
Nihon Kokyuki Gakkai Zasshi. 1998 Nov;36(11):994-7.
A 51-year-old man had been treated at a nearby hospital since 1993 for rheumatoid arthritis. Right pectoralgia developed in December 1994, and the patient consulted a nearby hospital, which detected right pleural effusion retention was pointed out on chest x-ray films. The patient was referred and admitted to our hospital. Rheumatic pleurisy was suspected because of a high serum rheumatoid factor(RF)level and high RF and high rheumatoid arthritis hemagglutination levels in the pleural effusion. However, due to a high adenosine deaminase level in the pleural effusion tuberculous pleurisy could not be ruled out. After drainage through a trocar catheter, the thoracic cavity was examined by thoracoscopy through the site of catheter insertion. As a result, sporadic bluish white nodular lesions were observed on the pleura. Granuloma formations presenting a palisade arrangement of giant cells were also observed, and pathologically diagnosed as rheumatoid nodules, thus providing the basis for a diagnosis of rheumatic pleurisy. Treatment with an increased dose of prednisolone achieved a rapid remission of the pleural effusion. Our experience underscored the usefulness of thoracoscopy as a means diagnosing of rheumatic pleurisy.
一名51岁男性自1993年起在附近医院接受类风湿关节炎治疗。1994年12月出现右胸痛，患者前往附近医院就诊，胸部X光片显示右侧胸腔积液。患者被转诊至我院并入院。由于血清类风湿因子（RF）水平升高以及胸腔积液中RF和类风湿关节炎血凝水平升高，怀疑为风湿性胸膜炎。然而，由于胸腔积液中腺苷脱氨酶水平较高，不能排除结核性胸膜炎。通过套管针导管引流后，经导管插入部位进行胸腔镜检查。结果，在胸膜上观察到散在的蓝白色结节性病变。还观察到呈现巨细胞栅栏状排列的肉芽肿形成，病理诊断为类风湿结节，从而为风湿性胸膜炎的诊断提供了依据。增加泼尼松龙剂量治疗使胸腔积液迅速缓解。我们的经验强调了胸腔镜作为诊断风湿性胸膜炎手段的有用性。
