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Baba A, Kurokawa R, Fukuda T, Kurokawa M, Tsuyumu M, Matsushima S, Ota Y, Yamauchi H, Ojiri H, Srinivasan A. Comprehensive radiological features of laryngeal sarcoidosis: cases series and systematic review. Neuroradiology 2022; 64:1239-1248. [PMID: 35246700 DOI: 10.1007/s00234-022-02922-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/20/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE To comprehensively summarize the characteristic radiological findings of laryngeal sarcoidosis. METHODS We reviewed patients with laryngeal sarcoidosis who underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) and included 8 cases from 8 publications that were found through a systematic review and 6 cases from our institutions. Two board-certified radiologists reviewed and evaluated the radiological images. RESULTS Almost all cases exhibited supraglottic lesions 13/14 (92.9%) and most of them involved aryepiglottic folds (12/13, 92.3%), epiglottis (11/14, 78.6%), and arytenoid region (10/14, 71.4%). Most lesions were bilateral (12/14, 85.7%). All cases showed well-defined margins and a diffuse swelling appearance (14/14, 100%). Non-contrast CT revealed a low density (4/5, 80%). The contrast-enhanced CT showed a slight patchy enhancement predominantly at the margin of the lesion in most cases (12/13, 92.3%). In one case, T2-weighted images showed high signal intensity peripherally and low signal intensity centrally (1/1, 100%). Gadolinium-enhanced MRI showed moderate heterogeneous enhancement predominantly at the margin of the lesion (2/2, 100%). In one case, diffusion-weighted imaging showed intermediate signal intensity; the apparent diffusion coefficient value was 2.4 × 10-3 mm2/s. The larynx was the only region affected by sarcoidosis in 57.1% (8/14) of the cases. Involvement of the neck lymph nodes and distant organs was observed in 4/14 (28.6%) patients, respectively. CONCLUSION We summarized the CT and MRI findings of patients with laryngeal sarcoidosis. Knowledge of these characteristics is expected to facilitate prompt diagnosis and appropriate management.
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Affiliation(s)
- Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA. .,Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Matsusato Tsuyumu
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Satoshi Matsushima
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Hideomi Yamauchi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
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Minaya NJ, Rao V, Naunheim MR, Song PC. Laryngeal Subsite Analysis of Granulomatosis With Polyangiitis (Wegener's). OTO Open 2021; 5:2473974X211036394. [PMID: 34396029 PMCID: PMC8361530 DOI: 10.1177/2473974x211036394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To analyze specific intralaryngeal findings associated with granulomatosis with polyangiitis (GPA). Study Design Retrospective chart review. Setting Tertiary referral center. Methods A retrospective chart review was performed on all patients diagnosed with GPA who were evaluated at the laryngology division of Massachusetts Eye and Ear Infirmary between January 2006 and September 2019. Results Forty-four patients (14 male, 30 female) were evaluated for laryngeal pathology. The mean age at onset was 48 years. Nine patients (21%) were identified with only vocal fold disease, 11 (25%) with subglottic disease, and 8 (18%) with disease at the glottis and subglottis (transglottic). The remaining 16 patients (36%) had a normal airway upon examination although they presented with laryngeal symptoms. Patients with glottic disease had statistically significantly lower voice-related quality of life scores than patients with isolated subglottic stenosis. Conclusions Although laryngeal manifestations of GPA is often described as a subglottic disease presenting with respiratory symptoms, subsite analysis show that only 25% of patients had subglottic disease alone, with similar rates of glottic disease alone. Laryngeal subsites have different epithelial mucosa, function, and physiology, and understanding the specific sites of involvement will determine symptoms and enable better analysis of the underlying mechanisms of disease. Glottic disease is associated with a reduction in vocal fold motion and voice changes. Subglottic involvement presents more frequently with airway symptoms. Further research is necessary to better define the specific regions of laryngeal involvement in patients diagnosed with GPA.
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Affiliation(s)
- Natasha J Minaya
- Department of Otolaryngology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Vishwanatha Rao
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew R Naunheim
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Phillip C Song
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Edriss H, Kelley JS, Demke J, Nugent K. Sinonasal and Laryngeal Sarcoidosis-An Uncommon Presentation and Management Challenge. Am J Med Sci 2018; 357:93-102. [PMID: 30665498 DOI: 10.1016/j.amjms.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/03/2018] [Accepted: 11/14/2018] [Indexed: 12/23/2022]
Abstract
Sarcoidosis is a chronic inflammatory disease of uncertain etiology characterized by the formation of noncaseating granulomas. The thorax is involved in 95% of cases, but any organ can be involved. Sinonasal or laryngeal involvement is uncommon and can be difficult to diagnose. The reported incidence of sarcoidosis in the upper airway clearly depends on study characteristics, and this creates uncertainty about the actual incidence. In a large prospective study in the United States, upper respiratory tract involvement occurred in 3% of the patients. Some patients have upper airway involvement without thoracic disease, and this presentation may cause delays in diagnosis. These patients have nonspecific symptoms which range from minimal nasal stuffiness to life-threatening upper airway obstruction. Currently, there is no established standard therapy for the management of upper airway sarcoidosis. These patients often respond poorly to nasal and/or inhaled corticosteroids and require long courses of oral corticosteroids. Patients with poor responses to oral corticosteroids or severe side effects may respond to tumor necrosis factor alpha inhibitors. In this review, we will discuss the clinical presentation, pathogenesis, diagnostic tests, drug treatment, surgical management options and the challenges clinicians have managing these patients.
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Affiliation(s)
- Hawa Edriss
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
| | - John S Kelley
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joshua Demke
- Department of Otolaryngology, Facial Plastic & Reconstructive Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Edriss H, Kelley J, Demke J. Sinonasal and Laryngeal Sarcoidosis. Proc (Bayl Univ Med Cent) 2017; 30:452-454. [DOI: 10.1080/08998280.2017.11930226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Hawa Edriss
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - John Kelley
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joshua Demke
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Hintze JM, Gnagi SH, Lott DG. Sarcoidosis Presenting as Bilateral Vocal Fold Immobility. J Voice 2017; 32:359-362. [PMID: 28684250 DOI: 10.1016/j.jvoice.2017.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/19/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
Bilateral true vocal fold paralysis is rarely attributable to inflammatory diseases. Sarcoidosis is a rare but important etiology of bilateral true vocal fold paralysis by compressive lymphadenopathy, granulomatous infiltration, and neural involvement. We describe the first reported case of sarcoidosis presenting as bilateral vocal fold immobility caused by direct fixation by granulomatous infiltration severe enough to necessitate tracheostomy insertion. In addition, we discuss the presentation, the pathophysiology, and the treatment of this disease with a review of the literature of previously reported cases of sarcoidosis-related vocal fold immobility. Sarcoidosis should therefore be an important consideration for the otolaryngologist's differential diagnosis of true vocal fold immobility.
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Affiliation(s)
- Justin M Hintze
- Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Sharon H Gnagi
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Phoenix, Arizona
| | - David G Lott
- Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic, Phoenix, Arizona; Department of Otorhinolaryngology, Mayo Clinic Arizona, Phoenix, Arizona.
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Yamasue M, Nureki SI, Ushijima R, Mukai Y, Goto A, Kadota JI. Sarcoidosis Presenting as Bilateral Vocal Cord Paralysis due to Bilateral Vagal Nerve Involvement. Intern Med 2016; 55:1229-33. [PMID: 27150886 DOI: 10.2169/internalmedicine.55.5441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a rare case of sarcoidosis presenting as bilateral vocal cord paralysis due to bilateral vagal nerve involvement. A 72-year-old woman with uveitis of the left eye complained of hoarseness and aspiration due to bilateral vocal cord paralysis. An endobronchial needle aspiration biopsy specimen of the mediastinal lymph nodes showed non-caseating epithelioid cell granuloma. Total protein and cell concentrations in the cerebrospinal fluid were increased. We diagnosed her to have sarcoidosis with bilateral vagal nerve involvement. Corticosteroid therapy improved her symptoms of hoarseness and aspiration. Sarcoidosis should therefore be taken into consideration as a potential cause of bilateral vocal cord paralysis.
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Affiliation(s)
- Mari Yamasue
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
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Mastan S, Advani R, Stobbs N, Kumar N. A rare manifestation of a multisystemic disease: a case of vocal cord palsy secondary to sarcoidosis. BMJ Case Rep 2015; 2015:bcr2015209728. [PMID: 25917073 PMCID: PMC4422924 DOI: 10.1136/bcr-2015-209728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/04/2022] Open
Abstract
We describe a rare case of recurrent laryngeal nerve neuritis secondary to sarcoidosis. A 40-year-old woman presented with persistent dysphonia. This was her first episode of dysphonia with no reports of laryngeal trauma. Fibre-optic laryngoscopy revealed a normal nasal passage, nasopharynx and pharynx. The supraglottic structures were all unremarkable; however, inspection of the true vocal cords revealed a left vocal cord palsy that was identified as being in a paramedian position. Radiological investigation showed mediastinal adenopathy that measured up to 20 mm in the short axis diameter. Histological examination showed granulomatous lymphadenitis of the lymph node with a central area of sclerosis surrounded by discrete, non-caseating granuloma. Stains for acid-fast bacilli were negative. The morphological features were suggestive of sarcoidosis. The lymphadenopathy distribution and size did not suggest left recurrent laryngeal nerve compression, giving a subsequent diagnosis of recurrent laryngeal nerve neuritis secondary to sarcoidosis.
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Affiliation(s)
- Saleem Mastan
- Royal Albert Edward Infirmary, Manchester, Manchester, UK
| | - Rajeev Advani
- Royal Albert Edward Infirmary, Manchester, Manchester, UK
| | - Nicola Stobbs
- Royal Albert Edward Infirmary, Manchester, Manchester, UK
| | - Nirmal Kumar
- Department of ENT, Royal Albert Edward Infirmary, Wigan, UK
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Christoforidou A, Goudakos J, Bobos M, Lefkaditis E, Vital V, Markou K. Sarcoidosis-like granulomatosis of the hypopharynx as a complication of anti-TNF therapy. Am J Otolaryngol 2013; 34:268-72. [PMID: 23357593 DOI: 10.1016/j.amjoto.2012.12.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 12/24/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Sarcoidosis is a multisystem granulomatous disease of unknown etiology, occasionally presenting with signs and symptoms that occur within the head and neck. Recently, granulomatous reactions and cases of sarcoidosis have been reported in patients treated with anti-TNF agents. METHODS This report describes a 56-year-old man who developed sarcoidosis in the hypopharynx during adalimumab therapy for psoriatic arthritis. A retrospective review of the literature was performed using the PubMed database. RESULTS In our patient, a chronic granulomatous reaction consistent with sarcoidosis developed after 2 years of continuous treatment with adalimumab. The diagnosis of sarcoidosis was established by the typical well-formed non caseating granulomas on biopsy, after excluding all other granulomatous conditions. Following withdrawal of anti-TNF agents and a course of steroids, the clinical picture resolved. CONCLUSIONS The development of sarcoidosis during treatment with TNF-a antagonists represents a rare and paradoxical adverse event. To our knowledge this is the first case of sarcoidosis of the hypopharynx reported in the literature.
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Laryngeal teflonoma identified by Fourier-transform infrared microspectroscopy after forensic autopsy: An interesting tool for foreign material identification in forensic cases. Forensic Sci Int 2012; 214:e26-9. [DOI: 10.1016/j.forsciint.2011.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 07/10/2011] [Accepted: 07/18/2011] [Indexed: 11/19/2022]
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Mayerhoff RM, Pitman MJ. Atypical and disparate presentations of laryngeal sarcoidosis. Ann Otol Rhinol Laryngol 2010; 119:667-71. [PMID: 21049851 DOI: 10.1177/000348941011901004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sarcoidosis is a multisystem chronic granulomatous disease of unknown cause that typically affects patients between 20 and 40 years of age. Laryngeal involvement most frequently involves the supraglottis and presents with dyspnea. We present a retrospective review of 4 patients with previously undiagnosed sarcoidosis who presented with atypical signs and symptoms of sarcoidosis: dysphonia with isolated vocal fold involvement; cough and globus pharyngeus; pediatric sarcoidosis; and severe bilateral vocal fold paresis and dysphagia. Our aim is to highlight disparate presentations of laryngeal sarcoidosis, as well as the treatment options. Laryngeal sarcoidosis may present with atypical signs and symptoms and occasionally presents in pediatric patients. A high degree of suspicion is necessary for a correct diagnosis in these patients. Early diagnosis and proper management of laryngeal sarcoidosis is important, as the symptoms are debilitating and possibly life-threatening. Treatment may consist of local and systemic chemotherapy, and adjunctive procedures.
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Affiliation(s)
- Ross M Mayerhoff
- Stony Brook University School of Medicine, Stony Brook, New York, USA
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James JC, Simpson CB. Treatment of Laryngeal Sarcoidosis with CO 2 Laser and Mitomycin-C. Otolaryngol Head Neck Surg 2004; 130:262-4. [PMID: 14990925 DOI: 10.1016/s0194-59980301583-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Joshua C James
- Department of Orolaryngology-Head and Neck Surgery, The University of Texas Health Science Center-San Antonio, TX 78229-3900, USA
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