ISSN : IJCMI Volume 1 • Issue 2 • 1000145 January, 2014 Clinical Image http://dx.doi.org/10.4172/ijcmi.1000145 International Journal of Clinical & Medical Imaging Title : Rheumatoid Arthritis Under Corticosteroid Therapy Inês Neves 1 , Adriana Magalhães 1 1 Pulmonology Department, Hospital de São João; Faculty of Medicine of Porto University; Centro Hospitalar de São João, Porto Portugal. *Corresponding author: Pulmonology Department, Hospital de São João; Faculty of Medicine of Porto University; Centro Hospitalar de São João, Porto Portugal, E-Mail: [email protected] A 66 year-old female patient, with a history of rheumatoid arthritis under corticosteroid therapy, was admitted to the Pul- monology ward with cavitated pulmonary tuberculosis and a pneumothorax, with high flow bronchopleural air leak. Chest CT revealed pneumomediastinum, loculated right pneumothorax, and a communication, 48X32 cm, between the superior lobar bronchus and a parenchymal cavitation, communicating with the pleural space (Panel A). Fiberoptic bronchoscopy showed a huge hole at the entrance of the posterior segment of the right upper lobar bronchus (Panel B and Panel C), through which it was possible to pass the fiber-bronchoscope and visualize the chest tube inside the pleural cavity (Panel D). She had no had medical conditions to thoracic surgical intervention, and aſter 90 days of anti-tuberculosis treatment and thoracic drainage, there was a spontaneous cicatrisation of the fistula. Copyright: © 2014 Neves I . This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. A B C D