Review Question - QID 100944

The patient’s symptoms and radiograph are consistent with rheumatoid lung disease, which can lead to pulmonary fibrosis.

Pulmonary fibrosis is a restrictive lung disease that usually presents with dyspnea. Physical exam shows end-inspiratory rales and chest radiograph may show diffuse, bilateral interstitial opacities. Spirometry shows a restrictive pattern with reduced total lung capacity and vital capacity. The optimal treatment of pulmonary fibrosis in rheumatoid lung disease has not been elucidated; however, oral glucocorticoids are typically used and cyclophosphamide, azathioprine, hydroxychloroquine, d-penicillamine, and cyclosporine have all been reported to be beneficial as well.

Brown et al. review the characteristic findings of rheumatoid lung disease. They conclude that airways, vasculature, parenchyma, and pleura can all be involved, with variable amounts of pathologic inflammation and fibrosis.

Karmani et al. discuss the evaluation of chronic dyspnea. They argue that formal pulmonary function testing may be needed to establish a diagnosis of asthma, chronic obstructive pulmonary disease, or interstitial lung disease.

Image A shows a chest radiograph of a patient with "rheumatoid lung".

Incorrect Answers:
Answer 1: Chronic bronchitis would result in hyperinflation, flattened diaphragms and at times increased intersitial markings on chest radiograph.
Answer 2: Tension pneumothorax would result in the appearance of a collapsed lung on chest radiograph, classically described with a mediastinal shift.
Answer 3: Chest radiograph is not the ideal modality for detecting pulmonary emboli but can result in nonspecific signs of atelectasis, effusion, Westermark sign, and a Hampton hump.
Answer 5: While mitral stenosis as a result of rheumatoid disease is possible, the chest radiograph findings in this patient are charactetristic of pulmonary fibrosis and there is no definitive evidence of mitral stenosis.