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DOI: 10.1055/s-0044-1782656
Approach to Pulmonary Nodules in Connective Tissue Disease
Abstract
The assessment of pulmonary nodules is a common and often challenging clinical scenario. This evaluation becomes even more complex in patients with connective tissue diseases (CTDs), as a range of disease-related factors must also be taken into account. These diseases are characterized by immune-mediated chronic inflammation, leading to tissue damage, collagen deposition, and subsequent organ dysfunction. A thorough examination of nodule features in these patients is required, incorporating anatomic and functional information, along with patient demographics, clinical factors, and disease-specific knowledge. This integrated approach is vital for effective risk stratification and precise diagnosis. This review article addresses specific CTD-related factors that should be taken into account when evaluating pulmonary nodules in this patient group.
Keywords
nodule - rheumatoid - nodule; rheumatic - computed tomography - positron emission tomographyPublication History
Article published online:
28 March 2024
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References
- 1 Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246 (03) 697-722
- 2 Larici AR, Farchione A, Franchi P. et al. Lung nodules: size still matters. Eur Respir Rev 2017; 26 (146) 170025
- 3 Gould MK, Tang T, Liu I-LA. et al. Recent trends in the identification of incidental pulmonary nodules. Am J Respir Crit Care Med 2015; 192 (10) 1208-1214
- 4 Mazzone PJ, Lam L. Evaluating the patient with a pulmonary nodule: a review. JAMA 2022; 327 (03) 264-273
- 5 McWilliams A, Tammemagi MC, Mayo JR. et al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med 2013; 369 (10) 910-919
- 6 Wang S, Xu F, Wang Y. et al. Relevant risk factor and follow-up of lung nodules in physical examination with low-dose CT screening. Iran J Public Health 2023; 52 (02) 350-359
- 7 MacMahon H, Naidich DP, Goo JM. et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017. Radiology 2017; 284 (01) 228-243
- 8 Bankier AA, MacMahon H, Goo JM, Rubin GD, Schaefer-Prokop CM, Naidich DP. Recommendations for measuring pulmonary nodules at CT: a statement from the Fleischner Society. Radiology 2017; 285 (02) 584-600
- 9 de Koning HJ, van der Aalst CM, de Jong PA. et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med 2020; 382 (06) 503-513
- 10 Callister MEJ, Baldwin DR, Akram AR. et al; British Thoracic Society Pulmonary Nodule Guideline Development Group, British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 (Suppl. 02) ii1-ii54
- 11 Devaraj A, van Ginneken B, Nair A, Baldwin D. Use of volumetry for lung nodule management: theory and practice. Radiology 2017; 284 (03) 630-644
- 12 Aberle DR, Adams AM, Berg CD. et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365 (05) 395-409
- 13 Horeweg N, van Rosmalen J, Heuvelmans MA. et al. Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening. Lancet Oncol 2014; 15 (12) 1332-1341
- 14 Gaerte SC, Meyer CA, Winer-Muram HT, Tarver RD, Conces Jr DJ. Fat-containing lesions of the chest. Radiographics 2002; 22 Spec No: S61-S78
- 15 Truong MT, Ko JP, Rossi SE. et al. Update in the evaluation of the solitary pulmonary nodule. Radiographics 2014; 34 (06) 1658-1679
- 16 Nasrullah A, Fadl S, Ahuja J, Xu H, Kicska G. Radiographic signs and patterns in interstitial lung disease. Semin Roentgenol 2019; 54 (01) 66-72
- 17 Fletcher JW, Kymes SM, Gould M. et al. VA SNAP Cooperative Studies Group. A comparison of the diagnostic accuracy of 18F-FDG PET and CT in the characterization of solitary pulmonary nodules. J Nucl Med 2008; 49 (02) 179-185
- 18 Herder GJ, van Tinteren H, Golding RP. et al. Clinical prediction model to characterize pulmonary nodules: validation and added value of 18F-fluorodeoxyglucose positron emission tomography. Chest 2005; 128 (04) 2490-2496
- 19 Burris NS, Johnson KM, Larson PEZ. et al. Detection of small pulmonary nodules with ultrashort echo time sequences in oncology patients by using a PET/MR system. Radiology 2016; 278 (01) 239-246
- 20 Wu L-M, Xu J-R, Hua J. et al. Can diffusion-weighted imaging be used as a reliable sequence in the detection of malignant pulmonary nodules and masses?. Magn Reson Imaging 2013; 31 (02) 235-246
- 21 Palmucci S, Galioto F, Fazio G. et al. Clinical and radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Insights Imaging 2022; 13 (01) 108
- 22 Spagnolo P, Cordier J-F, Cottin V. Connective tissue diseases, multimorbidity and the ageing lung. Eur Respir J 2016; 47 (05) 1535-1558
- 23 Ahuja J, Arora D, Kanne JP, Henry TS, Godwin JD. Imaging of pulmonary manifestations of connective tissue diseases. Radiol Clin North Am 2016; 54 (06) 1015-1031
- 24 Myasoedova E, Crowson CS, Kremers HM, Therneau TM, Gabriel SE. Is the incidence of rheumatoid arthritis rising?: results from Olmsted County, Minnesota, 1955-2007. Arthritis Rheum 2010; 62 (06) 1576-1582
- 25 de Lauretis A, Veeraraghavan S, Renzoni E. Review series: Aspects of interstitial lung disease: connective tissue disease-associated interstitial lung disease: how does it differ from IPF? How should the clinical approach differ?. Chron Respir Dis 2011; 8 (01) 53-82
- 26 Messina R, Guggino G, Benfante A, Scichilone N. Interstitial lung disease in elderly rheumatoid arthritis patients. Drugs Aging 2020; 37 (01) 11-18
- 27 Bilgici A, Ulusoy H, Kuru O, Celenk C, Unsal M, Danaci M. Pulmonary involvement in rheumatoid arthritis. Rheumatol Int 2005; 25 (06) 429-435
- 28 Demoruelle MK, Weisman MH, Simonian PL. et al. Brief report: airways abnormalities and rheumatoid arthritis-related autoantibodies in subjects without arthritis: early injury or initiating site of autoimmunity?. Arthritis Rheum 2012; 64 (06) 1756-1761
- 29 Wilsher M, Voight L, Milne D. et al. Prevalence of airway and parenchymal abnormalities in newly diagnosed rheumatoid arthritis. Respir Med 2012; 106 (10) 1441-1446
- 30 Cottin V, Hirani NA, Hotchkin DL. et al. Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases. Eur Respir Rev 2018; 27 (150) 180076
- 31 Shaw M, Collins BF, Ho LA, Raghu G. Rheumatoid arthritis-associated lung disease. Eur Respir Rev 2015; 24 (135) 1-16
- 32 Yousem SA, Colby TV, Carrington CB. Lung biopsy in rheumatoid arthritis. Am Rev Respir Dis 1985; 131 (05) 770-777
- 33 Kumar V, Abbas AK, Aster JC. eds. Robbins & Cotran Pathologic Basis of Disease. 10th ed. Philadelphia, PA:: Elsevier; 2021
- 34 Nyhäll-Wåhlin B-M, Turesson C, Jacobsson LTH. et al. The presence of rheumatoid nodules at early rheumatoid arthritis diagnosis is a sign of extra-articular disease and predicts radiographic progression of joint destruction over 5 years. Scand J Rheumatol 2011; 40 (02) 81-87
- 35 Tilstra JS, Lienesch DW. Rheumatoid nodules. Dermatol Clin 2015; 33 (03) 361-371
- 36 Koslow M, Young JR, Yi ES. et al. Rheumatoid pulmonary nodules: clinical and imaging features compared with malignancy. Eur Radiol 2019; 29 (04) 1684-1692
- 37 Sharma A, Kasetty A, Kumar A. Rheumatoid lung nodules with “feeding-vessel” sign. Clin Rheumatol 2021; 40 (04) 1645-1647
- 38 Chansakul T, Dellaripa PF, Doyle TJ, Madan R. Intra-thoracic rheumatoid arthritis: Imaging spectrum of typical findings and treatment related complications. Eur J Radiol 2015; 84 (10) 1981-1991
- 39 van Ede A, den Broeder A, Wagenaar M, van Riel P, Creemers MCW. Etanercept-related extensive pulmonary nodulosis in a patient with rheumatoid arthritis. J Rheumatol 2007; 34 (07) 1590-1592
- 40 Toussirot E, Berthelot JM, Pertuiset E. et al. Pulmonary nodulosis and aseptic granulomatous lung disease occurring in patients with rheumatoid arthritis receiving tumor necrosis factor-alpha-blocking agent: a case series. J Rheumatol 2009; 36 (11) 2421-2427
- 41 Karadeniz H, Cindil E, Babaoğlu H. et al Treatment with biologic DMARDs may not adversely affect lung nodules in rheumatoid arthritis patients. Eur J Rheumatol 2022; 275-281
- 42 León-Sierra LP, Cajas-Santana LJ, Torres-Saavedra FA. Cavitating pulmonary nodule in rheumatoid arthritis: a case report. Rev Colomb Reumatol Engl Ed 2018; 25 (02) 146-148
- 43 Wickrematilake G. Complicated rheumatoid nodules in lung. Case Rep Rheumatol 2020; 2020: 6627244
- 44 Denton CP, Khanna D. Systemic sclerosis. Lancet 2017; 390 (10103): 1685-1699
- 45 Bouros D, Wells AU, Nicholson AG. et al. Histopathologic subsets of fibrosing alveolitis in patients with systemic sclerosis and their relationship to outcome. Am J Respir Crit Care Med 2002; 165 (12) 1581-1586
- 46 Solomon JJ, Olson AL, Fischer A, Bull T, Brown KK, Raghu G. Scleroderma lung disease. Eur Respir Rev 2013; 22 (127) 6-19
- 47 Li JC, Tadros S, Rosser F, Torok KS. Pulmonary nodules in juvenile systemic sclerosis: a case-series from the National Registry for Childhood Onset Scleroderma (NRCOS). Diagnostics (Basel) 2023; 13 (12) 2103
- 48 Kim EA, Johkoh T, Lee KS. et al. Interstitial pneumonia in progressive systemic sclerosis: serial high-resolution CT findings with functional correlation. J Comput Assist Tomogr 2001; 25 (05) 757-763
- 49 Remy-Jardin M, Remy J, Wallaert B, Bataille D, Hatron PY. Pulmonary involvement in progressive systemic sclerosis: sequential evaluation with CT, pulmonary function tests, and bronchoalveolar lavage. Radiology 1993; 188 (02) 499-506
- 50 Bowman SJ, Ibrahim GH, Holmes G, Hamburger J, Ainsworth JR. Estimating the prevalence among Caucasian women of primary Sjögren's syndrome in two general practices in Birmingham, UK. Scand J Rheumatol 2004; 33 (01) 39-43
- 51 Shiboski SC, Shiboski CH, Criswell L. et al; Sjögren's International Collaborative Clinical Alliance (SICCA) Research Groups. American College of Rheumatology classification criteria for Sjögren's syndrome: a data-driven, expert consensus approach in the Sjögren's International Collaborative Clinical Alliance cohort. Arthritis Care Res (Hoboken) 2012; 64 (04) 475-487
- 52 Ramos-Casals M, Font J, García-Carrasco M. et al. Primary Sjögren syndrome: hematologic patterns of disease expression. Medicine (Baltimore) 2002; 81 (04) 281-292
- 53 Flament T, Bigot A, Chaigne B, Henique H, Diot E, Marchand-Adam S. Pulmonary manifestations of Sjögren's syndrome. Eur Respir Rev 2016; 25 (140) 110-123
- 54 Casal Moura M, Navin PJ, Johnson GB. et al. Pulmonary nodules in patients with primary Sjögren's syndrome: causes, clinico-radiologic features, and outcomes. Respir Med 2020; 174: 106200
- 55 Matsuyama N, Ashizawa K, Okimoto T, Kadota J, Amano H, Hayashi K. Pulmonary lesions associated with Sjögren's syndrome: radiographic and CT findings. Br J Radiol 2003; 76 (912) 880-884
- 56 Koyama M, Johkoh T, Honda O. et al. Pulmonary involvement in primary Sjögren's syndrome: spectrum of pulmonary abnormalities and computed tomography findings in 60 patients. J Thorac Imaging 2001; 16 (04) 290-296
- 57 Schaefer-Prokop C, Elicker BM. Pulmonary manifestations of systemic diseases. In: Hodler J, Kubik-Huch RA, Von-Schulthess GK. eds. Diseases of the Chest, Breast, Heart and Vessels 2019–2022. Cham: Springer International Publishing; 2019: 127-138 . Available at: http://link.springer.com/10.1007/978-3-030-11149-6_11 Accessed January 20, 2024
- 58 Kassan SS, Thomas TL, Moutsopoulos HM. et al. Increased risk of lymphoma in sicca syndrome. Ann Intern Med 1978; 89 (06) 888-892
- 59 Hare SS, Souza CA, Bain G. et al. The radiological spectrum of pulmonary lymphoproliferative disease. Br J Radiol 2012; 85 (1015) 848-864
- 60 Voulgarelis M, Ziakas PD, Papageorgiou A, Baimpa E, Tzioufas AG, Moutsopoulos HM. Prognosis and outcome of non-Hodgkin lymphoma in primary Sjögren syndrome. Medicine (Baltimore) 2012; 91 (01) 1-9
- 61 Rodallec M, Guermazi A, Brice P. et al. Imaging of MALT lymphomas. Eur Radiol 2002; 12 (02) 348-356
- 62 Keraen J, Blanc E, Besson FL. et al. Usefulness of 18F-labeled fluorodeoxyglucose-positron emission tomography for the diagnosis of lymphoma in primary Sjögren's syndrome. Arthritis Rheumatol 2019; 71 (07) 1147-1157
- 63 Jeong YJ, Lee KS, Chung MP. et al. Amyloidosis and lymphoproliferative disease in Sjögren syndrome: thin-section computed tomography findings and histopathologic comparisons. J Comput Assist Tomogr 2004; 28 (06) 776-781
- 64 Baqir M, Lowe V, Yi ES, Ryu JH. 18F-FDG PET scanning in pulmonary amyloidosis. J Nucl Med 2014; 55 (04) 565-568
- 65 Prakash UBS. Respiratory complications in mixed connective tissue disease. Clin Chest Med 1998; 19 (04) 733-746 , ix
- 66 Gunnarsson R, Hetlevik SO, Lilleby V, Molberg Ø. Mixed connective tissue disease. Best Pract Res Clin Rheumatol 2016; 30 (01) 95-111
- 67 Sullivan WD, Hurst DJ, Harmon CE. et al. A prospective evaluation emphasizing pulmonary involvement in patients with mixed connective tissue disease. Medicine (Baltimore) 1984; 63 (02) 92-107
- 68 Bodolay E, Szekanecz Z, Dévényi K. et al. Evaluation of interstitial lung disease in mixed connective tissue disease (MCTD). Rheumatology (Oxford) 2005; 44 (05) 656-661
- 69 Lota HK. Interstitial lung disease in patients with mixed connective tissue disease. Thorax 2013; 68: 186
- 70 Lynch DA. Lung disease related to collagen vascular disease. J Thorac Imaging 2009; 24 (04) 299-309
- 71 Kozuka T, Johkoh T, Honda O. et al. Pulmonary involvement in mixed connective tissue disease: high-resolution CT findings in 41 patients. J Thorac Imaging 2001; 16 (02) 94-98
- 72 Palmucci S, Di Mari A, Cancemi G. et al. Clinical and radiological features of interstitial lung diseases associated with polymyositis and dermatomyositis. Medicina (Kaunas) 2022; 58 (12) 1757
- 73 Svensson J, Arkema EV, Lundberg IE, Holmqvist M. Incidence and prevalence of idiopathic inflammatory myopathies in Sweden: a nationwide population-based study. Rheumatology (Oxford) 2017; 56 (05) 802-810
- 74 Arakawa H, Yamada H, Kurihara Y. et al. Nonspecific interstitial pneumonia associated with polymyositis and dermatomyositis: serial high-resolution CT findings and functional correlation. Chest 2003; 123 (04) 1096-1103
- 75 Liu Y, Xu L, Wu H. et al. Characteristics and predictors of malignancy in dermatomyositis: analysis of 239 patients from northern China. Oncol Lett 2018; 16 (05) 5960-5968
- 76 Fujita J, Tokuda M, Bandoh S. et al. Primary lung cancer associated with polymyositis/dermatomyositis, with a review of the literature. Rheumatol Int 2001; 20 (02) 81-84
- 77 Debray M-P, Borie R, Revel M-P. et al. Interstitial lung disease in anti-synthetase syndrome: initial and follow-up CT findings. Eur J Radiol 2015; 84 (03) 516-523
- 78 McCarty DJ, Manzi S, Medsger Jr TA, Ramsey-Goldman R, LaPorte RE, Kwoh CK. Incidence of systemic lupus erythematosus. Race and gender differences. Arthritis Rheum 1995; 38 (09) 1260-1270
- 79 Hannah JR, D'Cruz DP. Pulmonary complications of systemic lupus erythematosus. Semin Respir Crit Care Med 2019; 40 (02) 227-234
- 80 Gould DM, Daves ML. Roentgenologic findings in systemic lupus erythematosus; an analysis of 100 cases. J Chronic Dis 1955; 2 (02) 136-145
- 81 Webb WR, Gamsu G. Cavitary pulmonary nodules with systemic lupus erythematosus: differential diagnosis. AJR Am J Roentgenol 1981; 136 (01) 27-31
- 82 Tamai H, Nishina N, Takeuchi T. Pulmonary vein vasculitis presenting as multiple pulmonary nodules in a patient with systemic lupus erythematosus. J Rheumatol 2019; 46 (03) 323-324
- 83 Willemink MJ, Persson M, Pourmorteza A, Pelc NJ, Fleischmann D. Photon-counting CT: technical principles and clinical prospects. Radiology 2018; 289 (02) 293-312
- 84 Aerts HJWL, Velazquez ER, Leijenaar RTH. et al. Decoding tumour phenotype by noninvasive imaging using a quantitative radiomics approach. Nat Commun 2014; 5 (01) 4006
- 85 Ardila D, Kiraly AP, Bharadwaj S. et al. End-to-end lung cancer screening with three-dimensional deep learning on low-dose chest computed tomography. Nat Med 2019; 25 (06) 954-961
- 86 Ma J, Wang Q, Ren Y, Hu H, Zhao J. . Automatic lung nodule classification with radiomics approach,” Proc. SPIE 9789, Medical Imaging 2016: PACS and Imaging Informatics: Next Generation and Innovations, 978906 (5 April 2016); Available at: https://doi.org/10.1117/12.2220768 . Accesssed March, 2024