La Pneumopathie Rhumatismale.

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Abstract
Summary Report of 7 cases of rheumatic pneumonia, 3 of which were fatal. Rheumatic pneumonia has to be considered not as a concomitant manifestation or as a complication of rheumatic disease but as part of the disease as well as the articular and cardiac involvements, which are of course much more frequent. From the anatomopathological point of view the disease is characterized by lesions of exsudative and exfoliative alveolitis and especially by lesions of the alveolar ducti, either exsudative (hyaline membranes) or proliferative (Masson’s nodules). Although these lesions cannot be absolutely considered as specific of rheumatic pneumonia, it is in rheumatic disease that they are by far the most extensive; if Masson’s nodules are found, the diagnostic may be looked upon almost as a certainty. No doubt whatsoever remains when typical rheumatismal lesions are present in other organs. Rheumatic pneumonia can take up various clinical aspects. In 6 out of 7 of the reported cases, the pneumopathy resulted in intense dyspnea. There was very often a disproportion between physical signs and severity of functional disorders; yet in quite a number of cases disseminated rales were noted and even signs of condensation seemed to us more frequent than in classical descriptions. In one case the clinical picture was very similar to that of lobar pneumonia. Clinically silent forms are also mentioned in the literature. The most typical radiological picture consists of patchy areas of clouding in the central part of pulmonary fields with a clear strip at the periphery. In other cases shadows could be seen on both bases or atypical infiltrations were observed. The authors consider differential diagnosis of pulmonary complications occurring in rheumatic disease. Even when typical articulatory symptoms are not present the possibility of an isolated pulmonary form of rheumatic disease must be considered. Prognosis of rheumatic pneumonia is severe. But this complication is not systematically fatal. Treatment is discussed. If effectiveness of cortico-surrenal hormones is to be hoped for, they ought to be prescrived at the very first signs of a respiratory involvement.

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