Abstract
BackgroundIn rare cases, rheumatoid pleural nodules can rupture into the pleural cavity to cause pneumothorax or empyema. We report successful surgical treatment of a patient with an intractable secondary pneumothorax due to rupture of a subpleural rheumatoid nodule into the pleural cavity.Case presentationA 75-year-old man with a medical history of rheumatoid arthritis, acute coronary syndrome, and diabetes was admitted to our hospital because of left chest pain and dyspnea. A chest X-ray and chest computed tomography (CT) scan showed a left pneumothorax and several small subpleural nodules with cavitation. Repeated pleurodesis via a chest tube failed to improve the pneumothorax, so we decided to perform thoracoscopic surgery. Air leakage was detected in the left upper lobe where the subpleural nodule was visible on chest CT. Resection of the lesion successfully resulted in resolution of the air leakage. The final pathological diagnosis of the subpleural nodule was a pulmonary rheumatoid nodule. The patient has had no evidence of recurrence of pneumothorax after surgery.ConclusionsWe obtained a final pathological diagnosis of a rheumatoid nodule that caused an intractable pneumothorax. Pneumothorax associated with rupture of rheumatoid nodules in the subpleural cavitary is difficult to treat with thoracoscopic surgery as a second-line treatment.
Highlights
In rare cases, rheumatoid pleural nodules can rupture into the pleural cavity to cause pneumothorax or empyema
Pneumothorax associated with rupture of rheumatoid nodules in the subpleural cavitary is difficult to treat with thoracoscopic surgery as a second-line treatment
We report successful surgical treatment of an intractable secondary pneumothorax due to rupture of a subpleural rheumatoid nodule into the pleural cavity
Summary
We obtained a final pathological diagnosis of a rheumatoid nodule that caused an intractable pneumothorax. Pneumothorax associated with rupture of rheumatoid nodules in the subpleural cavitary is difficult to treat with thoracoscopic surgery as a second-line treatment. Authors’ contributions All authors participated in the care of the patient. All authors participated in the acquisition, analysis, or interpretation of the data; drafting and revising of the manuscript; final approval of the paper; and agreement to be accountable for the integrity of the case report. All authors read and approved the final manuscript. Consent for publication The patient provided permission to publish the features of his case. The identity of this patient has been protected. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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