Correct!
2. Emphysema
The complaint of dyspnea, the mild obstruction on spirometry, the mild decrease in the diffusing capacity, and the centrilobular emphysema seen on the CT scan are all consistent with emphysema. Emphysema, bronchiectasis, and small pulmonary nodules have been reported with Sjögren’s syndrome (2,3). However, there are no nodules on the CT scan. Bronchiectasis usually presents with productive cough and is associated with central airways larger than the accompanied pulmonary artery.
A review of the high-resolution CT scan findings in Sjögren’s syndrome found an incidence of emphysema of 37% (9 of 24 patients) (2). A variety of other abnormalities were seen mostly commonly bronchiectasis (11 of 24), thin-walled parenchymal cysts (11 of 24), and small pulmonary nodules (11 or 24). Our patient’s smoking may have contributed to her emphysema but the diffuse involvement seen our patient is more consistent with the previous reports rather than the apical predominance seen with smoking-associated emphysema. Emphysema has also been reported in nonsmokers with Sjögren’s (3).
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