Rheumatic Lung Disease

History: 50 year old male with a history of rheumatoid arthritis presents with sudden onset right sided chest pain, shortness of breath, and hypoxia. 

Rheumatic Lung Disease: Single axial CT scan in lung windows shows the patient is status post right sided chest tube placement with right chest wall soft tissue emphysema. A small pneumothorax is present with nodularity evident along the right visceral pleura. Scattered paraseptal lucencies are seen, indicative of emphysema.

Given the history of rheumatoid arthritis and nodularity of the visceral pleura, this is likely a case of spontaneous pneumothorax secondary to a cavitating rheumatoid nodule. The most common lung abnormality in patients with rheumatoid arthritis is pleural thickening and nodularity, present in 75% of these patients on autopsy series.