A 67-Year-Old Man With Psoriatic Arthritis and New-Onset Dyspnea

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A 67-Year-Old Man With Psoriatic Arthritis and New-Onset Dyspnea Kee Fong Phang, MB ChB, Gim Gee Teng, MD, Lynette L.S. Teo, MB ChB, Ju Ee Seet, MB ChB, Chia Meng Teoh, MB ChB, Felicia S.W. Teo, BM BS, FCCP CHEST Volume 154, Issue 5, Pages e127-e134 (November 2018) DOI: 10.1016/j.chest.2018.07.026 Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 1 A, B, Posterior-anterior chest radiograph 6 mo prior to presentation (A) and at presentation (B) demonstrating interval lung volume loss and increased basal reticulations. CHEST 2018 154, e127-e134DOI: (10.1016/j.chest.2018.07.026) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 2 A-D, High-resolution CT scan at the level of the right interlobar pulmonary artery and left lower lobar pulmonary artery showing subpleural ground glass opacities (A), at the level of the left lower lobe superior segment showing bilateral traction bronchiectasis (B), at the lung bases showing extensive traction bronchiectasis and bronchiolectasis with honeycomb changes (C), and a coronal section showing extensive traction bronchiectasis with honeycombing in the lower lobes (D). Imaging was performed on a 64-slice CT scanner obtained at 1.0-mm slice thickness. CHEST 2018 154, e127-e134DOI: (10.1016/j.chest.2018.07.026) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 3 Surgical lung biopsy of the left lung revealing temporally homogeneous inflammatory process with relative preservation of the lung architecture (hematoxylin and eosin stain, original magnification ×40). CHEST 2018 154, e127-e134DOI: (10.1016/j.chest.2018.07.026) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 4 A-D, Representative high-resolution CT sections of the same cuts depicted in Figure 2 with interval resolution of ground glass opacities and lung re-expansion in some areas of both lower lobes. CHEST 2018 154, e127-e134DOI: (10.1016/j.chest.2018.07.026) Copyright © 2018 American College of Chest Physicians Terms and Conditions