The patient was a 58 year old male with a 4 year history of rheumatoid arthritis, and who died in respiratory failure. The external surface of the lung appears opaque, due to pleural thickening by fibrosis. In the left photo, a tear from adhesions demonstrates the underlying parenchyma.
The cut surface of the lung shows pleural thickening, along with 2 rheumatoid nodules and areas of honeycombing. The parenchymal histology is similar to that of usual interstitial pneumonitis but rheumatoid nodules and pleural changes in this clinical setting point to the correct diagnosis.
Contributed by Dr. Michael Klein