Collagen Vascular Disease: Rheumatoid Arthritis

Radiology

Figure 1

Inspiratory HRCT Image

Compare the subtle changes of mosaic perfusion (geographic areas of decreased lung attenuation with abnormally small vessels) in this lung with those on the expiratory image below.

 

Figure 2

Expiratory HRCT Image

Air trapping is present bilaterally.


Pathology

This woman with rheumatoid arthritis was also receiving penicillamine when progressive dyspnea developed.

bronchiole

Figure 3

The former airway here is identified by its location next to an artery. A small amount of smooth muscle remains. Cellular granulation tissue replaces the lumen and most of the wall.

Find the occluded bronchiole.

 

bronchiole1

Figure 4

In another section from the same patient, an elastic van Gieson stain shows preservation of the elastic layer around an airway obliterated by collagenous scar.

Find the occluded bronchiole.

Note the the normal alveolar parenchyma and the medial and adventitial thickening of the artery.

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Bronchiole occluded by loose connective tissue

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Bronchiole occluded by dense scar

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