Case report
Pleuropulmonary Complications of Rheumatoid Arthritis: A Thoracic Surgeon's Challenge

https://doi.org/10.1016/j.athoracsur.2009.06.093Get rights and content

Approximately 1% of patients with rheumatoid arthritis have chronic lung disease develop, which can lead to complications, including pneumothorax and bronchopleural fistula. Given the inflammatory changes found, along with the immunosuppressant regimen used in management, these complications are often recalcitrant to initial surgical maneuvers. Our goal in reviewing these patients is to demonstrate the escalation of therapeutic interventions that may be needed to ensure successful resolution of this challenging disease process.

Section snippets

Patient 1

Our first patient is a 58-year-old man who underwent standard talc pleurodesis for rheumatoid effusions 4 years prior. He subsequently presented to our institution with an empyema. We performed VATS exploration and noted diffuse rheumatoid nodular disease. After exploration, his pneumothorax resolved and he was discharged home.

Weeks later he returned again with empyema, and consequently he underwent a thoracotomy and decortication of the inflammatory rind. Intraoperatively we noted a small BPF

Comment

Extra-articular pathology is common in patients with RA; approximately 1% of patients have pleuropulmonary disease [1], which is usually asymptomatic. However, if nodular cavitation or necrosis occurs, then complications can develop that may be resistant to standard care.

Review of the current literature demonstrates the significance of our series. The reported success rate for VATS with pleurodesis as management of spontaneous pneumothorax is 97% in the absence of rheumatoid disease; long-term

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Cited by (12)

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    Citation Excerpt :

    Surgical intervention may also be required in the event of a bronchopleural fistula. It has been recently suggested that the typical management of bronchopleural fistulae, which includes video-assisted thoracoscopic surgical (VATS) pleurodesis, may not be successful in rheumatoid pleural disease.128 The presence of underlying rheumatoid nodules may hamper local healing, making early direct closure via thoracotomy worthy of consideration.

  • Bubbles in the Box: Recurrent Pneumothorax From Bronchopleural Fistula in Rheumatoid Arthritis

    2019, Journal of Investigative Medicine High Impact Case Reports
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