Sarcoidosis - Stage I
Pathophysiology: A non-caseating granulomatous disease of
unknown etiology. It is largely believed this is an immunologic
reaction to antigenic stimuli, probably inhaled antigens.
The
disease involves multiple organ systems including: lungs, heart,
skin, central and peripheral nervous systems, and bone. The
lung is the most commonly involved organ. Adenitis, vasculitis,
alveolitis, and DAD occur with resulting small nodular changes
and interstitial fibrosis. End stage lung changes and marked
lung distortion can occur.
Clinical Clues:
-
Sarcoid is one of
the DISCORDANT lung diseases. This can be vital
in diagnosis. The often marked lung findings are discordant
with the clinical findings; the patients are often
asymptomatic **
-
Sarcoidosis is the
“syphilis” of the chest and can look at times
like many diverse lung diseases and processes.
-
Check for
angiotensin converting enzyme (ACE) levels and serum calcium.
Imaging Clues:
-
pleural effusions
are rare, and rarely is the major finding
-
asymmetric or focal
adenopathy is rare at presentation
Staging of Sarcoidosis: (thoracic disease)
Stage 0: Disease elsewhere, no thoracic involvement
Stage I: Hilar, paratracheal, and aortopulmonary
adenopathy only (Garlin’s triad)
Stage II: Adenopathy and interstitial lung disease
changes
Stage III: Interstitial lung disease only
Stage IV: End stage lung changes with lung distortion
CXR/CT Findings (Stage I): “potato” hila: lobular and bulky
hilar, paratracheal, and aortopulmonary adenopathy.
“Aunt Sophies”: a differential gamut of hilar adenopathy
and enlarged hila
-
Enlarged central
pulmonary arteries: PAH, CHF, chronic lung sepsis (eg. CF,
chronic bronchiectasis)
-
Hilar and
mediastinal adenopathy:
−
Infections: granulomatous (eg. TB), viral (eg.
infectious mononucleosis)
−
Tumor: nodal metastases, lymphoma, local
infiltration of small cell cancer, Castleman's disease
−
Inflammatory: silicosis, berylliosis
−
Infiltrative diseases: eg. pulmonary amyloidosis
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