This patient was a former coal-miner and additionally suffers from rheumatoid disease.

The lungs are fibrotic, but not in the upper lobe fashion typically associated with pneumoconiosis.   In addition multiple nodules are present, which were unchanged over time-interval studies.

The emphysematous changes relates to a prior history of smoking.

A prior biopsy was performed and said to be fitting with the infamous membership exam condition of Caplan's syndrome.