title: Case 238: Spontaneous Pneumothorax Secondary to Intrapulmonary Necrobiotic Rheumatoid Nodule.
abstract: History A 54-year-old white woman with a history of rheumatoid arthritis who was taking glucocorticoids and methotrexate presented to the emergency department in December with worsening shortness of breath and chest heaviness for 1 week. She reported additional symptoms of weakness, headache, and arthralgia primarily involving her bilateral hands, wrist, ankles, and feet. She denied experiencing fevers, syncope or presyncope, focal neurologic deficits, chest pain, nausea, vomiting, unintentional weight loss, or recent trauma. Additional medical history included hypertension, asthma, degenerative disk disease, and migraine, all of which were reportedly controlled with medications. This patient had a smoking history of 80 pack-years, but she had quit smoking 2 months prior to presentation. She denied abuse of alcohol or recreational drugs and reported she was up-to-date on her immunizations, including those for pneumonia and flu. Family history was pertinent for breast cancer in her mother, sister, and maternal aunt. The patient reported normal findings at screening mammography and colonoscopy. A physical examination was remarkable for slightly asymmetric breath sounds, which appeared to be diminished on the right side. This patient had multiple joint deformities, most notably in the bilateral metacarpophalangeal joints. Initial electrocardiography findings and cardiac biomarkers were negative. Her complete blood count and basic metabolic profile were unremarkable. Posteroanterior and lateral chest radiographs were obtained in the emergency department. Subsequently, computed tomography (CT) of the chest was performed.
authors.affiliation: From the Department of Radiology, Stony Brook University Medical Center, HSC Level 4, Room 120, East Loop Road, Stony Brook, NY 11794 (Ammar A. Chaudhry, Abbas A. Chaudhry, W.M.); and Department of Internal Medicine, Winthrop University Hospital, Mineola, NY (M.G.).
authors.forename: Ammar A
authors.initials: AA
authors.lastname: Chaudhry
authors.affiliation: From the Department of Radiology, Stony Brook University Medical Center, HSC Level 4, Room 120, East Loop Road, Stony Brook, NY 11794 (Ammar A. Chaudhry, Abbas A. Chaudhry, W.M.); and Department of Internal Medicine, Winthrop University Hospital, Mineola, NY (M.G.).
authors.forename: Maryam
authors.initials: M
authors.lastname: Gul
authors.affiliation: From the Department of Radiology, Stony Brook University Medical Center, HSC Level 4, Room 120, East Loop Road, Stony Brook, NY 11794 (Ammar A. Chaudhry, Abbas A. Chaudhry, W.M.); and Department of Internal Medicine, Winthrop University Hospital, Mineola, NY (M.G.).
authors.forename: Abbas A
authors.initials: AA
authors.lastname: Chaudhry
authors.affiliation: From the Department of Radiology, Stony Brook University Medical Center, HSC Level 4, Room 120, East Loop Road, Stony Brook, NY 11794 (Ammar A. Chaudhry, Abbas A. Chaudhry, W.M.); and Department of Internal Medicine, Winthrop University Hospital, Mineola, NY (M.G.).
authors.forename: William
authors.initials: W
authors.lastname: Moore
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D009336:Necrosis; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology*; D013902:Radiography, Thoracic; D012218:Rheumatoid Nodule / Q000150:complications* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed