Rheumatoid lung nodules with "feeding-vessel" sign.

Ashish Sharma, Abhinetri Kasetty, Ashok Kumar

Clinical rheumatology 2021 Apr

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Rheumatoid arthritis is a systemic inflammatory disease which causes symmetric polyarthritis. Lungs are common site for extra-articular involvement. Rheumatoid lung nodules occur in about 32% of patients with rheumatoid arthritis. The appearance of a lung nodule, along with the blood vessel supplying it, is called "feeding-vessel" sign on computed tomography. It is most commonly seen in infections. However, it can also be present in metastases and pulmonary vasculitis. We describe a woman with long-standing rheumatoid arthritis with subcutaneous and pulmonary nodules. Computed tomography of the chest showed "feeding-vessel" sign. There was no evidence of infection, malignancy, or vasculitis. She was treated for rheumatoid lung nodulosis with rituximab with which she improved remarkably. To the best of our knowledge, "feeding-vessel" sign in rheumatoid lung nodules has never been reported before. This case highlights the fact that "feeding-vessel" sign is not specific for pulmonary infections. It can rarely be seen in rheumatoid lung nodulosis.