Cavitary Pulmonary Nodules in Rheumatoid Arthritis: A 17-Year Imaging Follow-Up of Necrobiotic Granulomas.

Document Type

Article

Publication Date

5-12-2026

Publication Title

Cureus

Abstract

Pulmonary necrobiotic granulomas are a rare extra-articular manifestation of rheumatoid arthritis (RA) that may radiographically mimic infection or malignancy. We present a 57-year-old woman with RA and a smoking history who was found to have subpleural cavitary pulmonary nodules on computed tomography (CT). A biopsy confirmed necrobiotic granulomas. Serial imaging over a 17-year period demonstrated a fluctuating course, including enlargement of lesions from 1.4 cm to 4.4 cm, development of new cavitary nodules, fluid-filled transformation, and partial spontaneous regression. Despite marked radiographic progression, the patient remained clinically stable and was managed conservatively with multidisciplinary follow-up. To our knowledge, such prolonged longitudinal imaging follow-up of rheumatoid pulmonary nodules is rare. This case highlights the prolonged and variable natural history of RA-associated pulmonary nodules and underscores the importance of recognizing their imaging characteristics to prevent unnecessary invasive intervention. Long-term surveillance may be appropriate in asymptomatic patients despite radiologic progression.

Volume

18

Issue

5

First Page

108740

DOI

10.7759/cureus.108740

ISSN

2168-8184

PubMed ID

42291866

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