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Computed tomography findings of Caplan syndrome.

We report a case of Caplan syndrome complicated with tuberculosis, which was clinically followed up for 18 years and underwent autopsy. Initial chest radiograph showed 2 large nodules against the background of smaller pneumoconiotic nodules. One of the large nodules showed cavitation during follow-up. Computed tomography (CT) was helpful in identifying calcification in another large nodule. Autopsy confirmed the 2 large nodules as burned-out rheumatoid nodules and revealed additional rheumatoid nodules that were indistinguishable from silicotic nodules by CT.

Caplan Syndrome↗

Caplan's syndrome.

Caplan's syndrome is characterized by the presence of seropositive rheumatoid arthritis associated with a specific form of pneumoconiosis, consisting of multiple, well-defined homogeneous rounded opacities on chest X-ray. It develops especially in miners working in anthracite coal-mines and in persons exposed to silica and asbestos. In the development of the disease, genetic factors are considered to play an important role by influencing immunological reactivity of the organism exposed to various heteroantigens.

Caplan Syndrome↗

[Caplan syndrome].

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Arthritis↗

[Biventricular inflow tract compression by chronic organized hemopericardium in Caplan syndrome].

We report the case of a 59-year old patient with the rare combination of silicosis and rheumatoid arthritis, which is called Caplan's syndrome. The patient presented with right heart failure caused by a pericardial tumor compressing the right and the left ventricle. By means of several imaging techniques it was possible to elucidate the topographic relations of the tumor. Definite signs of malignant growth were not found. Despite his elevated perioperative risk we decided to operate on the patient. During the operation macroscopic and histologic evidence revealed that the tumor was not a neoplastic process but consisted of an organized hemopericardium. This demonstrates that pericarditis in rheumatoid arthritis can be hemorrhagic and can mimick a malignant pericardial tumor. The decision to operate was first supported by the findings of the applied imaging techniques, the normal endomyocardial biopsy, and the clinical course and were later confirmed in situ.

Caplan Syndrome↗