Case reportPleuropulmonary Complications of Rheumatoid Arthritis: A Thoracic Surgeon's Challenge
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)
Pyopneumothorax in rheumatoid arthritis
2017, Revue des Maladies RespiratoiresSystemic Diseases and the Pleura
2011, Archivos de BronconeumologiaPleuropulmonary involvement leading to bilateral pneumothorax in a patient being treated for rheumatoid arthritis
2010, Revue des Maladies RespiratoiresPulmonary Manifestations of Rheumatoid Arthritis
2010, Clinics in Chest MedicineCitation 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
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