Atypical presentation of rheumatoid arthritis: a case of massive bilateral pleural effusions in a patient with Caplan syndrome.

Rheumatoid arthritis (RA) is a common connective tissue disorder affecting the synovial joints. In patients with RA, involvement of the lungs occurs in 30%-40% of cases while pleural effusions occur in only 3%-5%. However, the majority of RA-associated pleural effusions are small, unilateral and asymptomatic. We present a case of massive bilateral pleural effusions in a patient with established rheumatoid pneumoconiosis (Caplan syndrome). Interestingly, the pleural effusion occurred following recent treatment for minimal change disease and atrial fibrillation.

[New possibilities of making the diagnosis of Caplan syndrome]. / Nowe mozliwosci rozpoznawania zespolu Caplana.

We describe a 56-year old man with rheumatoid arthritis and pulmonary nodules detected by HRCT. Needle biopsy confirmed the diagnosis of Caplan syndrome.

Computed tomography findings of Caplan syndrome.

We report a case of Caplan syndrome complicated with tuberculosis, which was clinically followed up for 18 years and underwent autopsy. Initial chest radiograph showed 2 large nodules against the background of smaller pneumoconiotic nodules. One of the large nodules showed cavitation during follow-up. Computed tomography (CT) was helpful in identifying calcification in another large nodule. Autopsy confirmed the 2 large nodules as burned-out rheumatoid nodules and revealed additional rheumatoid nodules that were indistinguishable from silicotic nodules by CT.

[Pleural and pulmonary changes within the scope of rheumatoid arthritis]. / Pleurale und pulmonale Veränderungen im Rahmen der rheumatoiden Arthritis.

Pulmonary complications caused by rheumatoid arthritis are a clinically relevant aspect of this chronic arthropathy. Those complications can involve all parts of the thorax, including the lung parenchyma, the pleura, and the thoracic cage. The most common complications are necrobiotic nodules, pleural abnormalities, Caplan's syndrome, parenchymal fibrosis, bronchiolitis obliterans, and iatrogenic damage of lung the parenchyma. This article reviews pulmonary abnormalities induced by rheumatoid arthritis and their clinical and radiological findings. In addition, the role of different imaging modalities in the diagnostic work-up of pulmonary complications caused by rheumatoid arthritis is discussed.

Kaolinosis: a radiological review.

A short account of the industrial process used to produce kaolin is given. The chest radiographs of 68 selected cases of kaolinosis were reviewed and the radiological appearances are presented. We also describe two cases of Caplan's syndrome occurring in kaolinosis.

[Radiographic diagnosis in the early recognition and evaluation of incapacitating sequelae of advanced rheumatoid arthritis]. / Diagnostica radiografica nella diagnosi precoce e nella valutazione dei postumi invalidanti di artrite reumatoide avanzata.

Two observed cases of rheumatoid arthritis, one at an initial, the other at a very advanced stage, form the basis for a detailed report on the radiographic signs of the disease. Particular emphasis is placed on the possibilities offered by the various radiographic techniques for the evaluation of the sequelae of rheumatoid arthritis and for the early diagnosis of the disease.

Pulmonary function in coal workers with Caplan's syndrome and non-rheumatoid complicated pneumosoniosis.

This retrospective study compares the pulmonary function of 24 coal workers with Caplan's syndrome with that of 36 subjects with non-rheumatoid progressive massive fibrosis (PMF). Allowing for differences in radiographical category, age, years worked underground, and smoking, obstruction to air flow as reflected in the one-second forced expiratory volume, the vital capacity, and the ratio of residual volume to total lung capacity, was significantly less in subjects with Caplan's syndrome. No significant differences in transfer factor were found. These findings may be explained by the different pathological features of the two entities. Selection bias does not appear to be responsible for the differences observed between the groups, but studies designed to eliminate this would be desirable.

[Lung and pleural involvement in collagen disease (author's transl)]. / Lungen- und Pleurabefall bei Kollagenosen

Frequency and type of pulmonary and pleural involvement in collagen disease (rheumatoid arthritis, progressive systemic scleroderma, polymyositis-dermatomyositis and lupus erythematodes are analysed on the basis of literature and of own cases with particular regard to the roentgenographic appearance.