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Es-Sabbahi B, Ezzine M, Aamara B, Alami B, Serraj M. Pseudotumor Sarcoidosis: The Contribution of Thoracic MRI to the Presumption of Benignity of a Pulmonary Lesion Process. Cureus 2023; 15:e37485. [PMID: 37187637 PMCID: PMC10177681 DOI: 10.7759/cureus.37485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Sarcoidosis is a benign systemic disease; its diagnosis is based on a suggestive radiological presentation, and the isolation of an epithelioid and gigantocellular granuloma (EGGC) without caseous necrosis with the elimination of other causes of granuloma. However, sometimes the radiological presentation is atypical and misleading, posing problems in terms of differential diagnosis. In this report, we present a case of pseudotumor sarcoidosis, in which MRI played an essential role in characterizing the lesion and suggesting its benignity. We also discuss the role of MRI in evaluating atypical forms of sarcoidosis.
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Affiliation(s)
| | - Maha Ezzine
- Pulmonology Department, Hassan II University Hospital, Fez, MAR
| | - Bouchra Aamara
- Pulmonology Department, Hassan II University Hospital, Fez, MAR
| | | | - Mounia Serraj
- Pulmonology Department, Hassan II University Hospital, Fez, MAR
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2
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Ansari-Gilani K, Chalian H, Rassouli N, Bedayat A, Kalisz K. Chronic airspace disease: Review of the causes and key computed tomography findings. World J Radiol 2020; 12:29-47. [PMID: 32368328 PMCID: PMC7191307 DOI: 10.4329/wjr.v12.i4.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/09/2019] [Accepted: 01/28/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic airspace diseases are commonly encountered by chest, body or general radiologists in everyday practice. Even though there is significant overlap in the imaging findings of different causes of chronic airspace disease, some key clinical, laboratory and imaging findings can be used to guide the radiologist to the correct diagnosis. The goal of this article is to review and compare these features.
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Affiliation(s)
- Kianoush Ansari-Gilani
- Department of Radiology, University Hospitals, Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Hamid Chalian
- Department of Radiology, Duke University Medical Center, Durham, NC 27705, United States
| | - Negin Rassouli
- Department of Radiology, University Hospitals, Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Arash Bedayat
- Department of Radiological Sciences, University of California-Los Angeles, Los Angeles, CA 90095, United States
| | - Kevin Kalisz
- Department of Radiology, Northwestern University, Chicago, IL 60611, United States
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3
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Kawakami N, Moriya T, Wakai Y, Saito K. Acute alveolar sarcoidosis in a 25-year-old man. Postgrad Med J 2020; 96:113. [DOI: 10.1136/postgradmedj-2019-136993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/07/2019] [Indexed: 11/04/2022]
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Alveolar Sarcoidosis With Intense FDG Uptake, Mimicking Multi-focal Pneumonia and Infiltrative Lung Malignancy. Clin Nucl Med 2019; 44:653-654. [DOI: 10.1097/rlu.0000000000002637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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5
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Iranmanesh AM, Washington L. Pulmonary Sarcoidosis: A Pictorial Review. Semin Ultrasound CT MR 2019; 40:200-212. [DOI: 10.1053/j.sult.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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6
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Meyer KC. Lung transplantation for pulmonary sarcoidosis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:92-107. [PMID: 32476942 DOI: 10.36141/svdld.v36i2.7163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 02/04/2019] [Indexed: 01/15/2023]
Abstract
Although relatively few patients with pulmonary sarcoidosis develop advanced disease that progresses to respiratory insufficiency despite receiving best practice pharmacologic interventions, lung transplantation may be the only therapeutic option for such patients to both prolong survival and provide improved quality of life. Lung transplant can be successfully performed for patients with end-stage pulmonary sarcoidosis, and post-transplant survival is similar to that for other transplant indications such as idiopathic pulmonary fibrosis. However, appropriate timing of referral, comprehensive assessment of potential candidates for lung transplant, placement of patients on the lung transplant waiting list when within the transplant window as appropriate, choosing the best procedure (bilateral versus single lung transplant), and optimal peri-operative and post-transplant management are key to successful lung transplant outcomes for patients with sarcoidosis.
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Affiliation(s)
- Keith C Meyer
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
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McCabe P, Wig S. Galaxy sign in alveolar sarcoidosis: An unusual radiological presentation of Lofgren’s syndrome. Rheumatology (Oxford) 2017; 56:2128. [DOI: 10.1093/rheumatology/kex359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abdelhedi H, Khammassi N, Mhenni A, Kort Y, Cherif O. [Pulmonary sarcoidosis presenting as multiple scattered pulmonary nodules: about a case]. Pan Afr Med J 2016; 24:295. [PMID: 28154650 PMCID: PMC5267871 DOI: 10.11604/pamj.2016.24.295.7664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 08/19/2015] [Indexed: 11/11/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease that can affect all organs, thoracic involvement often predominates representing its most evocative manifestation. Atypical manifestations, such as the presence of multiple scattered pulmonary nodules may indicate malignancy. Our study reports the case of a 56-year-old patient investigated for asthenia associated with paresthesia of the lower limbs evolving since 6 months. Chest CT scan showed multiple scattered pulmonary nodules. Histological examination of specimens obtained by bronchial biopsy allowed to exclude neoplastic origin and confirmed the diagnosis of sarcoidosis. On the basis of normal pulmonary function tests and the absence of extrapulmonary visceral involvement, simple patient monitoring was recommended. Radiologically sarcoidosis can exceptionally present as multiple scattered pulmonary nodules. Histological evidence is necessary to exclude other etiologies including tumors. Corticosteroids are indicated only in the presence of severe respiratory functional impairment and/or associated visceral involvement.
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Affiliation(s)
- Haykel Abdelhedi
- Service de Médecine Interne, Hôpital Razi, la Manouba 2010, Faculté de Médecine de Tunis, Tunis Tunisie
| | - Naziha Khammassi
- Service de Médecine Interne, Hôpital Razi, la Manouba 2010, Faculté de Médecine de Tunis, Tunis Tunisie
| | - Amira Mhenni
- Service de Médecine Interne, Hôpital Razi, la Manouba 2010, Faculté de Médecine de Tunis, Tunis Tunisie
| | - Youssef Kort
- Service de Médecine Interne, Hôpital Razi, la Manouba 2010, Faculté de Médecine de Tunis, Tunis Tunisie
| | - Ouahida Cherif
- Service de Médecine Interne, Hôpital Razi, la Manouba 2010, Faculté de Médecine de Tunis, Tunis Tunisie
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Gera K, Panjabi C, Dash D, Shah A. Cavitary alveolar sarcoidosis complicated by an aspergilloma. BMJ Case Rep 2014; 2014:bcr-2014-206280. [PMID: 25326564 DOI: 10.1136/bcr-2014-206280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Cavitation in pulmonary sarcoidosis is rather unusual and even rarer in the alveolar form of the disease. A review of the literature revealed only 13 documented patients with cavitating alveolar sarcoidosis. Of the 13 patients, clinical information was available in only eight cases. Aspergilloma complicating cavitary alveolar sarcoidosis has been documented only once before. A 38-year-old woman with progressive dyspnoea for 3 years presented owing to a bout of haemoptysis. Imaging prior to presentation demonstrated mediastinal lymphadenopathy and coalescent parenchymal alveolar opacities along with air bronchograms, suggestive of alveolar sarcoidosis. On presentation, cavitations were visible in both lungs within the consolidation along with an intracavitary mass in the left upper lobe, which on evaluation was recognised as an aspergilloma. Bronchoscopy disclosed non-caseating granulomas on histopathology confirming pulmonary sarcoidosis. Cavitary alveolar sarcoidosis with aspergilloma formation can result in a diagnostic dilemma, especially in endemic tuberculous areas.
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Affiliation(s)
- Kamal Gera
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | - Devijyoti Dash
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Ashok Shah
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Gera K, Gupta N, Ahuja A, Shah A. Acute alveolar sarcoidosis presenting with hypoxaemic respiratory failure. BMJ Case Rep 2014; 2014:bcr-2013-202247. [PMID: 24789154 DOI: 10.1136/bcr-2013-202247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Alveolar sarcoidosis is a less commonly seen pulmonary manifestation of the disease. An acute presentation of this radiological pattern with hypoxaemic respiratory failure has been documented only once, four decades ago. A 30-year-old man presented with acute onset of progressive and persistent dyspnoea over 20 days ago with hypoxaemic respiratory failure. Imaging demonstrated mediastinal lymphadenopathy and coalescent parenchymal alveolar opacities having ill-defined margins along with air bronchograms in the mid and lower zones bilaterally, suggestive of alveolar sarcoidosis. A restrictive pattern with a diffusion defect was seen on pulmonary function testing. Bronchoscopic evaluation revealed non-caseating granulomas on histopathology confirming pulmonary sarcoidosis. This was further supported by an elevated serum ACE level and negative Mantoux test. Oral prednisolone elicited a rapid clinical and radiological response. Alveolar sarcoidosis can rarely present acutely with hypoxaemic respiratory failure, which can respond remarkably and expeditiously to appropriate therapy.
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Affiliation(s)
- Kamal Gera
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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12
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Msaad S, Ketata W, Abid N, Abid H, Ayadi L, Mnif J, Boudawara T, Ayoub A. [Pseudotumor phenotype of sarcoidosis: about two cases]. Rev Mal Respir 2013; 30:794-800. [PMID: 24267772 DOI: 10.1016/j.rmr.2013.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 03/11/2013] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Sarcoidosis is a multisystem benign granulomatous disease of unknown etiology. It can sometimes cause diagnostic confusion by presenting in the form of a pseudotumor, thus constituting a trap for the unwary. COMMENTS The authors report two cases of pseudotumor sarcoidosis. In the first, the pseudotumor occurred in the context of multisystem disease in a 48-year-old man. The response to treatment with systemic corticosteroids was complicated by the development of disseminated tuberculosis, which was rapidly fatal. The second case, by contrast, was about a 58-year-old woman and the disease was self-limiting, resolving spontaneously in less than 3 months. CONCLUSION Through these two cases, the authors focus on the particularities of the pseudotumor manifestation of pulmonary sarcoidosis. The diagnosis is often difficult. The mismatch between the clinical picture and the extent of radiological lesions should, however, suggest the diagnosis. Histological evidence is needed to eliminate other etiologies including malignant tumors. The condition usually resolves either spontaneously or after treatment with systemic corticosteroids. However, relapses are possible, including on discontinuation of corticosteroid therapy.
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Affiliation(s)
- S Msaad
- Service de pneumologie, CHU Hédi-Chaker de Sfax, route el Ain Km1, 3029 Sfax, Tunisie.
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Sharma SK, Soneja M, Sharma A, Sharma MC, Hari S. Rare manifestations of sarcoidosis in modern era of new diagnostic tools. Indian J Med Res 2012; 135:621-9. [PMID: 22771590 PMCID: PMC3401691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND & OBJECTIVES Growing body of literature on sarcoidosis in India has led to an increased awareness of the disease. With the advent of better imaging tools hitherto under-recognized manifestations of sarcoidosis are likely to be better recognized. We sought to study the rare clinical and radiological manifestations (<5%) in patients with sarcoidosis. METHODS Retrospective review of records of 164 patients with histopathologically proven sarcoidosis seen over six years in a tertiary care centre in north India, was done. RESULTS Fifty four rare manifestations were observed in 164 patients. Acute presentation in the form of Lofgren syndrome was seen in eight (4.9%) and Heerfordt's syndrome in two (1.2%) patients. Musculoskeletal manifestations included chronic sarcoid arthritis in three (1.8%), deforming arthritis and bone erosion in one (0.6%) each. Rare initial presentation with dilated cardiomyopathy in one (0.6%), complete heart block in two (1.2%), bilateral sequential facial nerve palsy in two (1.2%), and pyrexia of unknown origin was seen in one (0.6%) patient. Other rare manifestations included chronic respiratory failure in one (0.6%), dysphagia in one (0.6%), sicca syndrome in five (3%), massive splenomegaly in one (0.6%), portal hypertension in two (1.2%), hypersplenism, gastric sarcoidosis, ninth and tenth cranial nerve palsies, moderate pericardial effusion and nephrocalcinosis in one (0.6%) each, and pulmonary artery hypertension in two (1.2%) patients. Rare radiological manifestations included moderate pleural effusion in two (1.2%), pleural thickening in five (3%), calcification of intrathoracic lymph nodes in four (2.4%), alveolar (nodular) sarcoidosis in three (1.8%), and myocardial uptake of 18F-fluorodeoxyglucose (F-18 FDG) in two (1.2%) patients. Fourteen patients had airways obstruction and behaved typically like seasonal bronchial asthma with excellent response to corticosteroids. INTERPRETATION & CONCLUSIONS Increased awareness of rare manifestations will facilitate better management of these patients. With increasing use of modern diagnostic tools, manifestations hitherto considered rare, are likely to be recognized more frequently in the future.
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Affiliation(s)
- Surendra K Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India,Reprint requests: Dr. S.K. Sharma, Head, Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India e-mail:
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Sharma
- Department of Medicine, University of Medicine, Pleven, Bulgaria
| | - Mehar C. Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Hari
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Hawtin KE, Roddie ME, Mauri FA, Copley SJ. Pulmonary sarcoidosis: the 'Great Pretender'. Clin Radiol 2010; 65:642-50. [PMID: 20599067 DOI: 10.1016/j.crad.2010.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 03/03/2010] [Accepted: 03/10/2010] [Indexed: 01/15/2023]
Abstract
Sarcoidosis has a wide spectrum of appearances within the thorax. This review will discuss and illustrate the range of pulmonary manifestations on high-resolution computed tomography and chest radiography, concentrating on atypical features and examples of sarcoidosis mimicking other lung diseases. All included cases have been histologically confirmed. Such variable imaging appearances should alert the radiologist to consider sarcoidosis as a differential diagnosis in the context of interstitial lung disease.
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Affiliation(s)
- K E Hawtin
- Department of Radiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Baughman RP, Shipley R, Desai S, Drent M, Judson MA, Costabel U, du Bois RM, Kavuru M, Schlenker-Herceg R, Flavin S, Lo KH, Barnathan ES. Changes in Chest Roentgenogram of Sarcoidosis Patients During a Clinical Trial of Infliximab Therapy. Chest 2009; 136:526-535. [DOI: 10.1378/chest.08-1876] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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16
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The clinical and radiologic features of nodular pulmonary sarcoidosis. Lung 2008; 187:9-15. [PMID: 18843518 DOI: 10.1007/s00408-008-9118-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 09/08/2008] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVES Nodular sarcoidosis is an uncommon presentation of sarcoidosis. Our objective was to describe the clinical characteristics of a large cohort of patients with nodular sarcoidosis. METHODS We performed a retrospective study of patients with nodular sarcoidosis diagnosed at an urban teaching hospital over a 10-year period. RESULTS Thirty-three patients with nodular sarcoidosis were identified. All patients were African-American. The mean age was 35 and the female-to-male ratio was 5:1. Twenty-six patients were current or former smokers. All patients had chest CT scan and/or chest radiograph evidence of pulmonary masses. Twenty-seven patients had multiple pulmonary masses/nodules and six had solitary pulmonary nodules/masses. The upper lobes were involved in 27 patients. Mediastinal lymphadenopathy and pleural-based masses were present in 30 and 20 patients, respectively. Extrapulmonary manifestations were present in 14 patients. All patients had tissue diagnosis of noncaseating granulomas with negative culture. Twenty-two patients underwent bronchoscopy with transbronchial biopsies, which were diagnostic in 19. Follow-up data were available on 27 patients: complete or nearly complete resolution of the pulmonary masses--either spontaneously or with systemic treatment--was documented for 19 patients, no change in the radiologic findings for 7 patients, and progression to pulmonary fibrosis for 1 patient. CONCLUSIONS Nodular sarcoidosis is a rare presentation of pulmonary sarcoidosis. It usually presents with multiple pulmonary masses that tend to be peripheral and are associated with mediastinal lymphadenopathy. Bronchoscopy with transbronchial biopsies has high diagnostic yield. Despite its ominous presentation, nodular sarcoidosis has favorable prognosis.
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Akbar JJ, Meyer CA, Shipley RT, Vagal AS. Cardiopulmonary Imaging in Sarcoidosis. Clin Chest Med 2008; 29:429-43, viii. [DOI: 10.1016/j.ccm.2008.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Kim HK, Ban HJ, Chi SY, Chae DR, Cho GJ, Lim JH, Ju JY, Kwon YS, Oh IJ, Kim KS, Kim YI, Lim SC, Kim YC. A Case of Pseudoalveolar Sarcoidosis with Unilateral Pulmonary Infiltration. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.64.2.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hee Jung Ban
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Su Young Chi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Ryeol Chae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Gye Jung Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Hwan Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jin Yung Ju
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Soo Kwon
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - In Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyu Sik Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yu Il Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Chul Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young Chul Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Abstract
Sarcoidosis is an immune system disorder characterised by non-necrotising granulomas. Pulmonary involvement is the most common presentation of sarcoidosis, but it can manifest in any organ. Other commonly involved organ systems include the lymph nodes (especially the intrathoracic nodes); the skin; the eyes; the liver; the heart; and the nervous, musculoskeletal, renal, and endocrine systems. The typical and atypical imaging features of multisystemic involvement of sarcoidosis have been discussed with review of the gamut of radiological manifestations of thoracic, cardiac, CNS, abdominal and musculoskeletal sarcoidosis.
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Affiliation(s)
- Achala S Vagal
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH 45267-0761, USA
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20
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Ibn Sellam A, Zahraoui R, Soualhi M, Chaibainou A, Benamor J, Bourkadi JE, Iraqi G. [The pseudoalveolar form of sarcoïdosis: a diagnostic pitfall]. Rev Mal Respir 2006; 23:367-72. [PMID: 17127915 DOI: 10.1016/s0761-8425(06)71605-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Sarcoïdosis is a benign systemic granulomatosis whose aetiology remains unknown. Lung is the most frequently involved organ. The pseudoalveolar form of this disease is known to have an acute onset and is quite uncommon. Therefore, diagnosing such a rare variety of sarcoidosis is rather often challenging. OBSERVATIONS In the present article, the authors report two cases of pseudoalveolar sarcoidosis. The patients, both young adults, showed no suggestive signs of sarcoidosis at first presentation. This resulted in a considerable delay to diagnosis and to the corticosteroid therapy. CONCLUSION The authors emphasize the rarity of the pseudoalveolar form of sarcoidosis. They insist on its roentgenographic characteristics and demonstrate the functional benefits allowed by the precocious medical management. They also propose a current review of the literature.
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Affiliation(s)
- A Ibn Sellam
- Service de Pneumologie, Hôpital Moulay Youssef, CHU Ibn Sina, Rabat, Maroc.
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Girvin F, Vlahos I. A 30-Year-Old Man With a History of Polysubstance Abuse and Hepatitis C Presents With Exertional Dyspnea and Patchy Ground-Glass Opacities. Chest 2006; 130:1608-11. [PMID: 17099044 DOI: 10.1378/chest.130.5.1608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Francis Girvin
- New York School of Medicine/New York University and Bellevue Medical Center, New York, NY 10016, USA.
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22
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Bredin C, Margery J, Garcin JM. [A rare cause of multinodular thoracic tumors]. Rev Med Interne 2005; 26:664-5. [PMID: 16054518 DOI: 10.1016/j.revmed.2005.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 01/17/2005] [Indexed: 01/15/2023]
Affiliation(s)
- C Bredin
- Service des maladies digestives, hôpital d'instruction-des-armées-Legouest, BP 10, 57998 Metz-Armées, France.
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23
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Lungenerkrankungen unklarer Ätiologie. Thorax 2003. [DOI: 10.1007/978-3-642-55830-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 4-2001. A 26-year-old man with pain, erythema, and swelling of the legs. N Engl J Med 2001; 344:443-9. [PMID: 11172182 DOI: 10.1056/nejm200102083440608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Marlow TJ, Krapiva PI, Schabel SI, Judson MA. The "fairy ring": a new radiographic finding in sarcoidosis. Chest 1999; 115:275-6. [PMID: 9925098 DOI: 10.1378/chest.115.1.275] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A patient who had the "fairy ring" finding shows another new radiographic presentation of pulmonary sarcoidosis that clinicians can add to the list of signs of the disease.
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Affiliation(s)
- T J Marlow
- Department of Radiology, Medical University of South Carolina, Charleston 29425, USA
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26
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Abstract
Sarcoidosis involves the bronchi or lung in more than 90 percent of patients. Intrathoracic manifestations are protean, ranging from asymptomatic bilateral hilar lymphadenopathy to chronic, progressive, (ultimately fatal), respiratory insufficiency. The clinical course is highly variable, and optimal management and treatment are controversial. We review the salient radiographic, physiologic, and histopathologic features of pulmonary sarcoidosis and discuss rare intrathoracic complications (e.g., bronchostenosis, mycetomas, nodular sarcoidosis, necrotizing sarcoid angiitis and granulomatosis, pulmonary vascular and pleural involvement). We discuss the chest radiographic staging system and the role of ancillary diagnostic modalities including high resolution thin section computed tomographic scans (HRCT), bronchoalveolar lavage, radionuclide scan, and serum angiotensin enzyme converting enzyme. Indications for therapy and an overview of therapeutic options are outlined.
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Affiliation(s)
- J P Lynch
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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Israel HL, Karlin P, Menduke H, DeLisser OG. Factors affecting outcome of sarcoidosis. Influence of race, extrathoracic involvement, and initial radiologic lung lesions. Ann N Y Acad Sci 1986; 465:609-18. [PMID: 3460398 DOI: 10.1111/j.1749-6632.1986.tb18537.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chest roentgenograms of 152 patients with type 2/3 disease observed 3 or more years were reviewed using modified ILO/UC nomenclature. After a mean length of observation of 9.3 years, clinical recovery was observed in 71.7% and radiologic recovery in 48.0% of the patients. Age; duration of observation; mediastinal adenopathy; and character (xyz, pgr, stu), size, extent, and profusion of pulmonary densities were similar in the 53 white and 99 black patients, who differed significantly only in sex distribution. White patients achieved clinical recovery (84.9%) more often than black patients (64.7%) (p = .05). Factors influencing clinical recovery were analyzed by means of stepwise logistic linear regression. The initial roentgenographic features were unrelated to outcome; only race and extrathoracic disease proved to have significant predictive value. The probability of clinical recovery is estimated to be .894 in white patients with disease limited to the chest, .697 in white patients with extrathoracic disease, and .760 in black patients without and .454 in black patients with extrathoracic sarcoidosis. Recovery appears to be related not to the severity of the initial pulmonary reaction but to racially associated factors that influence extrathoracic dissemination as well as lung damage.
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 41-1984. A 65-year-old woman with hemoptysis, weight loss, bilateral pulmonary nodules, and past breast cancer. N Engl J Med 1984; 311:969-78. [PMID: 6472423 DOI: 10.1056/nejm198410113111508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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