Normal Single Coronary Artery and Myocardial

matoid disease on histologic evaluation of the pulmonary and subcutaneous lesions together. The pulmonary lesion had extensive fibrosis, as well as necrosis, and appeared to be a late relatively quiescent lesion. Angiitis was found within but not outside this lesion. Granulomatous infection was unlikely because cultures of the sputum and lung biopsy failed to grow mycobacterial or fungal organisms and because the pulmonary nodules slowly multiplied and enlarged over ten years without other evidence of localized or disseminated infection. Thus, although the findings in the lung alone were consistent with either Wegener's granulomatosis or a rheumatoid nodule, such late scarred lesions are best described as nondiagnostic; however, in combination with the subcutaneous lesion, we believe that the diagnosis of rheumatoid nodule is most appropriate for both lesions. We considered the possibility that our patient first developed limited Wegener's granulomatosis and later developed unrelated subcutaneous nodules and rheumatoid factor. The combination of rheumatoid disease and Wegener's granulomatosis has been reported previously in three c a ~ e s ; ~ ~ ~ ~ ~ however, all had arthritis, and none had pulmonary parenchymal lesions. Although we cannot exclude the above combination, the absence of typical vasculitis outside the scarred lesion in our patient's lung militates against it. Thus, we believe that our case represents the unusual development of pulmonary rheumatoid nodules over ten years in the absence of clinical features of rheumatoid arthritis.