Most effusions associated with RA pleurisy are asymptomatic and do not require specific
treatment. Initial treatment of pleuritis with nonsteroidal anti-inflammatory agents may suffice. Some patients respond to corticosteroids, but others do not, and the role of corticosteroid injections into the pleural space is questionable . Occasionally, persistent symptomatic effusions or pleural thickening necessitate decortication, but this therapy is quite invasive . Wrightson et al. reported this website 6 patients who developed arthritis-associated pseudochylothorax that occurred without pleural thickening and had only a short duration of symptoms , which suggests that early detection of RA pleurisy may be possible and could be valuable for prevention of restrictive changes of the pleura. The authors have no conflicts of interest, financial or otherwise. “
“A 76-year-old male, a lifelong nonsmoker with a past medical history of bronchiectasis, atypical mycobacterial infection and pulmonary aspergillosis was evaluated for a progressively enlarging nodule in the lateral segment of the right middle lobe measuring about 13 mm × 8 mm in largest
dimension (Fig. 1). An area of central necrosis within the nodule was also observed on the CT scan. Physical examination was unremarkable. A video-assisted thoracoscopic surgery (VATS) with wedge biopsy of the lesion was performed for suspicion of an underlying malignancy. The pathology showed severe chronic bronchitis and bronchiectasis. There was an area of infarcted lung with fragments of necrotic Inhibitor Library material containing remnants of Dirofilaria immitis within this area of necrosis ( Figs. 2 and 3). Patient had an uneventful recovery and was discharged home. Pharmacological treatment was not considered since complete resection is thought to be curative. Multiple repeat imaging on follow up visits have not shown any recurrence. Dirofilaria sp are roundworms oxyclozanide belonging to the phylum Nematoda which are known to infect a variety of mammals. Human dirofilariasis is usually
transmitted by the bite of an infected mosquito, which acts as a vector and then transmits the third stage D. immitis larva into the skin. Other species namely Dirofilaria repens, and Dirofilaria tenuis are also known to infect humans but not in the United States. The first clinical case report of human pulmonary dirofilariasis (HPD) was described by Dashiell in 1961 . It tends to be an incidental diagnosis on histopathological examination of lung tissue that has been biopsied on the suspicion of a cancer . Historically, this is a disease of middle-aged adults with most disease reported in the age group between 40 and 50 years of age . Young people undergo imaging less frequently than adults which may explain the higher incidence seen in the elderly.