Splenic siderotic nodules, also known as Gamna Gandi’s bodies are nodules containing hemosiderin, fibrous tissue and calcium and result of small necrotic haemorrhagic focis in the spleen with a fibroblastic reaction leading to microarchitectural distorsion. Anatomopathological examination show bamboo-shaped small circumscribed nodular siderotic deposits corresponding to fibrous collagenous tissue, impregnated with iron pigments (hemosiderin) and calcium. Herein, we display images of Gamna Gandi’s bodies in a 55-year-old patient with a history of chronic portal thrombosis resulting in portal hypertension. Gamna Gandi’s bodies are easily detected, in most cases on the various cross-sectional imaging techniques as a well-circumscribed millimeteric nodules, with a black central hemorrhage surrounded by a double rim, a pale inner hyperemic rim and a dark outer rim, giving an appearance of “tobacco flecks” (figure 2, D, arrow).

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Pulmonary air leak syndromes involve dissection of air out of the normal pulmonary airspaces and include pulmonary interstitial emphysema, pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, subcutaneous emphysema and systemic air embolism. It presents as a spontaneous extension of dissecting air without a history of a procedure or penetrating injury. Pulmonary air leak syndromes are extremely rare complications of systemic autoimmune connective tissue diseases. Few cases were reported in the literature regarding rheumatoid arthritis patients. The purpose of this article is to emphasize on this rare pulmonary complication and discuss the physiopathology of the disease and the different risk factors for a better management of these patients. We report the case of a 45-year-old female, with a history of proven rheumatoid arthritis under methotrexate and steroids, who presented with a spontaneous dissecting subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumoperitoneum. The patient’s condition improved after chest drainage and adjustment of her medical treatment.