Rheumatoid arthritis with 'tram-tracks and 'signet rings

A 54-year-old man presented with a history of cough, expectoration and breathlessness which had been worsening over the past 1 year. He did not have fever, night sweats or weight loss. He had been diagnosed to have rheumatoid arthritis 8 years ago. Examination showed synovitis in the metacarpophalangeal joints and wrists; deformities suggestive of rheumatoid arthritis were seen in multiple joints. Auscultation of the chest revealed bilateral infrascapular coarse crepitations. Interstitial lung disease and bronchiectasis were the likely differential diagnoses. A chest radiograph showed cystic and reticular changes in both lung fields. High resolution CT of the chest was remarkable for dilated airways with thickened walls. The appearance was like a ‘tram-track’ in longitudinal sections of the airways (figure 1A). In cross-section, the thickened airways along with the accompanying blood vessel resembled a ‘signet ring’ (figure 1B). These are classical features of bronchiectasis. The patient was...
Source: Postgraduate Medical Journal - Category: General Medicine Authors: Tags: Images Source Type: research