Endobronchial nodules in a patient with rheumatoid arthritis.

We report the case of a patient with rheumatoid arthritis who presented with endobronchial nodules. Endobronchial biopsy showed a large B cell lymphoma. Non-Hodgkin lymphoma rarely involves the endobronchial tree, and is typically treated with systemic chemotherapy, but in this case additional treatment with argon plasma coagulation was used for local control of the disease.

Spontaneous recovery in idiopathic unilateral diaphragmatic paralysis.

Idiopathic unilateral diaphragmatic paralysis is a rare condition that typically causes minimal symptoms, especially during exercise. Several reports indicated progressive improvement or even complete recovery to normal function of diaphragmatic paralysis that complicated various thoracic and extrathoracic conditions. In this case we describe a 57-year-old male with spontaneous recovery of idiopathic right hemidiaphragm paralysis and review reported cases of reversible diaphragmatic dysfunction.

The use of statins and lung function in current and former smokers.

BACKGROUND: Smokers are affected by a variety of inflammatory diseases, including COPD. Statins, 3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase inhibitors, are used for their lipid-lowering characteristics but also appear to have antiinflammatory and immunomodulatory activities. We assessed their ability to preserve lung function in current and former smokers. METHODS: All smokers and ex-smokers seen at the Oklahoma City VA hospital in 2005 with abnormal baseline spirometry findings and two or more pulmonary function tests done 6 months apart were classified into obstructive and restrictive groups based on the initial PFT result. Statin use, annual decline in FEV(1) and FVC, and need for respiratory-related urgent care (emergency department or inpatient) were compared. RESULTS: Approximately one half, 215 of 418 patients, were receiving a statin. Compared to the control group, statin users had a lower decline in FEV(1) (- 0.005 +/- 0.20 L/yr vs 0.085 +/- 0.17 L/yr, p < 0.0001) and FVC (- 0.046 +/- 0.45 L/yr vs 0.135 +/- 0.32 L/yr, p < 0.0001) [mean +/- SD]. This difference remained significant irrespective of whether the patient had obstructive (n = 319), or restrictive (n = 99) disease, and regardless of whether the patient continued or stopped smoking. In patients with an obstructive spirometry finding, we found a lower incidence of respiratory-related urgent care in favor of the statin group (0.12 +/- 0.29 patient-years vs 0.19 +/- 0.32/patient-years; p = 0.02). CONCLUSION: In smokers and former smokers, statins are associated with a slower decline in pulmonary function, independent of the underlying lung disease. CLINICAL IMPLICATION: Prospective, randomized trials are needed to study the effect of statins on lung function.

Rounded atelectasis with atypical computed tomography findings.

Rounded atelectasis is atelectasis of the peripheral part of the lung, typically in contact with thickened pleura, featuring characteristic computed tomography findings. In this case, a 61-year-old man with history of asbestos exposure presented with a right-middle-lobe nodule on chest radiograph, with computed tomography findings suspicious for neoplasm. The patient underwent surgical resection, which revealed rounded atelectasis. Our case raises a question about the sensitivity of radiographic criteria used in identifying rounded atelectasis, and it emphasizes the need to keep rounded atelectasis in the differential diagnosis of a single pulmonary nodule in a patient with a history of asbestos exposure.