A 55-year-old man with seropositive rheumatoid arthritis presents with multiple painless subcutaneous nodules on the extensor surfaces of the forearms and fingers. Chest radiograph shows multiple well-defined round opacities in both lung fields. The most likely diagnosis is:

• A Pulmonary metastases
• B Rheumatoid nodules ✓
• C Tuberculosis
• D Granulomatosis with polyangiitis

Explanation

Rheumatoid nodules are the most common extra-articular manifestation of rheumatoid arthritis and occur in 20-30% of seropositive patients. They can appear on extensor surfaces and, when present in the lungs, manifest as multiple, well-defined pulmonary nodules that may cavitate. Pulmonary metastases are less likely without a known primary malignancy. Tuberculosis and granulomatosis with polyangiitis can cause pulmonary nodules but are not associated with the characteristic subcutaneous nodules of rheumatoid arthritis.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.