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Related Experiment Videos

A single pulmonary rheumatoid nodule masquerading as malignancy.

P V Voulgari1, N Tsifetaki, Z M Metafratzi

  • 1Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.

Clinical Rheumatology
|May 24, 2005
PubMed
Summary

A solitary pulmonary nodule in a smoker was diagnosed as a rheumatoid nodule, a rare initial sign of rheumatoid arthritis (RA). This highlights the diagnostic challenge in differentiating rheumatoid nodules from lung cancer.

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Area of Science:

  • Rheumatology
  • Pulmonology
  • Pathology

Background:

  • Familial hypercholesterolemia and smoking are common risk factors for cardiovascular and pulmonary diseases.
  • Solitary pulmonary nodules (SPNs) in smokers often raise concerns for malignancy, necessitating thorough diagnostic evaluation.
  • Rheumatoid nodules are typically associated with established rheumatoid arthritis (RA) and extra-articular manifestations.

Observation:

  • A 54-year-old male smoker with familial hypercholesterolemia presented with an enlarging asymptomatic SPN.
  • Laboratory tests revealed elevated rheumatoid factor and acute phase reactants.
  • Open lung biopsy, performed due to suspicion of malignancy, revealed histological features consistent with a rheumatoid nodule.

Findings:

  • The histological findings of the SPN were identical to those of a co-existing subcutaneous nodule.

Related Experiment Videos

  • This case represents an extremely rare instance of a pulmonary rheumatoid nodule as the initial presentation of RA.
  • The clinical and radiological presentation mimicked pulmonary carcinoma, underscoring the need for histologic confirmation.

    • Implications:

    • Pulmonary rheumatoid nodules can mimic lung cancer, posing a diagnostic challenge, especially in smokers.
    • Rheumatoid nodules should be considered in the differential diagnosis of SPNs, even in the absence of overt RA symptoms.
    • Histological examination is crucial for definitive diagnosis and appropriate patient management when encountering SPNs with atypical presentations.