A case report of extra-articular manifestation of rheumatoid arthritis: Rheumatoid nodules in lungs.

Rheumatoid arthritis is a systemic inflammatory disorder primarily affecting joints but not limited to the joints alone. Extra-articular manifestations involve skin, ocular, gastrointestinal, pulmonary, cardiac, renal, neurological, and hematological systems. Among them, skin manifestations (20%) are most common, presenting as nodules on the extensor surfaces of the upper and lower extremities. In rare cases these nodules can also be detected within the heart and lungs. Interestingly, rheumatoid nodules are often seen in patients on leflunomide, methotrexate, or tumor necrosis factor-alpha antagonists. Nevertheless, definitive diagnosis requires a histopathological analysis. In this case report, we presented a 49-year-old male patient with a relatively short period of disease activity leading to rheumatoid nodules in the lungs. Considering the ongoing COVID-19 pandemic and that tuberculosis was still endemic in Kazakhstan, achieving the definite diagnosis was challenging. Initial imaging study revealed bilateral polysegmental pneumonia. The tests for COVID-19 and pulmonary tuberculosis were negative. A follow-up chest computed tomography scan had signs of disseminated lung lesions of unknown origin. Lung biopsy showed a morphological picture of productive granulomas characteristic for tuberculosis. However, at the second look, typical scarring granulomas typically seen in rheumatoid nodules were observed.

Computed Tomography in the Preoperative and Postoperative Evaluation of Kidney Transplant Patients.

OBJECTIVES: Computed tomography is required for selection of living donors for kidney transplant. We assessed the diagnostic relevance and effectiveness of multiphase contrast-enhanced computed tomography angiography for evaluating patients before and after transplant. MATERIALS AND METHODS: Thirty-two potentially living kidney donors (15 men and 17 women) underwent multiphase computed tomography angiography for evaluation before kidney transplant and 2 posttransplant recipients under went this test owing to abnormal vascularization. Computed tomography angio graphy was used to determine parenchymal blood-flow conditions and vascular architecture of the kidney grafts. All of the 34 patients underwent prestudy Doppler ultrasonography. RESULTS: Additional renal arteries were found in 11 patients (32.3%). From them, a single additional renal artery, situated from the aorta to the lower segment of the kidney, was observed in 8 (72.7%) patients; dual additional renal arteries with equivalent caliber trunks were observed in 3 (27.3%) patients. An additional renal artery occurred more often in women in 6 (54.5%) donors. Concomitant renal pathology was detected in 3 (9.3%) of 32 donors: simple cysts in 2 donors and hydro nephrosis transformation in 1 donor. These 3 cases represented an accidental discovery and were therefore excluded from the list of donors. In addition, all donors underwent excretory-phase computed tomography, and their renal function and urinary collecting system results were evaluated. Two recipients with graft dysfunction presented with decreased venous return and delayed arterial filling of the renal arteries that manifested as delayed contrast in the kidney graft medulla. Renal parenchymal ischemic zones were consistent with microvasculature thrombosis, the most common cause of vascular complications in these recipients. CONCLUSIONS: Multiphase computed tomography angiography is a necessary tool for assessing the structure and condition of vascular architecture in kidney donors and recipients. Individuals with ambiguous Doppler results, this test should be required; it is also warranted when renal graft vascular complications are suspected.