Fig. 2.

Nodular pleural thickening simulating malignancy. 70-year-old female with history of rheumatoid arthritis (RA) and left breast cancer status post radiation therapy. (a) CT. Nodular left pleural thickening (arrows) in this patient is an indeterminate finding that may represent rheumatoid inflammation, malignancy or infection. (b) Pleural biopsy showed necrotizing granulomatous inflammation without evidence of malignancy. Gram, fungal, and acid-fast stains were negative for organisms.

Teaching point: Nodular pleural thickening in RA patients frequently mimics malignancy such as metastatic disease and mesothelioma.