Pulmonary sarcoidosis Flashcards
What is sarcoidosis?
Systemic disorder of unknown causes characterised by formation of NON caseating granulomas
Which organ is most commonly involved?
Lung - over 90%
What cells are involved?
T cells accuumulate
What evidence suggests that sarcoidosis is caused by infections?
Other granulomatous diseases have infectious causes
Can be transmitted via transplanted organs
Which infectious organisms are linked to sarcoidosis?
Proponi bacteria acnes (but research was done in Japanese people)
Mycobacteria
Risk factors
Agricultural exposures Insecticides Microbial bioaerosols FH Northern europe, USA and India African-americans
What is the strange thing about cigarettes and sarcoidosis?
Cigarette smoking is a protective factor !!
Sarcoid presentation differs by ethnicity. What is seen in Japanese?
Uveitis
Cardiac sarcoid
no ‘Lofgren’ ie bilateral hilar lymphadenopathy
Where are the sarcoid granulomas found?
Follow lymphatic pathways along interlobular septa and around the pleura
What are the characteristics of the pulmonary nodules?
bronchocentric
Signs
Erythema nodosum
Bilateral hilar lymphadenopathy
Calcified egg shell lymph nodes (bilateral) - note this is unilateral in TB
Staging name
Scadding staging on XRAY
Stage 1
Bilateral hilar lymphadenopathy + Right paratrachea
Classic signs of sarcoid on CT
Honeycomb - suggests end stage fibrosis
seen in UIP
usual interstitial pneumoniasis
Stage 3 signs
Parenchymal disease
WITHOUT Bilateral hilar lymphadenopathy + Right paratrachea (these have receded or never been present)
Stage 4 signs
Fibrosis
hilar being pulled up by hilar lymphosis
Diagnosis of stages 1-2
EBUS-TBNA
Diagnosis of stages 3-4
???
Stage 4 signs
Fibrosis
hilar being pulled up by hilar
lymph ??
Predictors of mortality
Pulmonary HTN
More than 20% fibrosis on CT
Within fibrotic disease, what do you have to look for?
Stable or progressive?
Therefore you have to try to measure disease activity
Assessing disease activity
HRCT BAL Serum ACE Lung function FDG-PET
Nodules seen on HRCT are reversible or irreversible?
reversible
Ground glass changes on HRCT is reversible or irreversible?
maybe reversible
Complication of sarcoid
Chronic pulmonary aspergillosis
Death in these patients with CPA is caused by?
Sarcoidosis rather than haemoptysis
Treatment of sarcoidosis
NSAIDS for joint pain
Low dose prednisolone or hydroxychloroquine
+ ???
Risks
Respiratory failure
Cardiac arrythmias
What’s the problem with cardiac involvement?
Many patients are asymptomatic !!!!!!!!!!!!! Autopsy shows 25% of patients actually have cardiac involvement
What questions would you ask to screen for cardiac involvement?
Palpitations
Syncope
SOB
What would you look for on ECG to screen for cardiac involvement?
AV block Frequent premature vetnricular ectopics/tachycardia LBBB/RBBb Q waves ?
Echo
??
Treatment
Corticosteroids
Immunosuppressants
What would you look for on ECG to screen for cardiac involvement?
AV block Frequent premature ventricular ectopics/tachycardia LBBB/RBBb Q waves ?
Echo
Wall thinning, thickening etc
??
Why are second line agents used
Osteoporosis
Diabetes
What do you use
Biologics e.g. inflixmab
Why are second line agents used
Pt often have comorbidities which means they can’t tolerate the corticosteroids
e.g.
Osteoporosis
Diabetes
What do you use if the other treatments don’t work?
Biologics e.g. infliximab
Symptoms
Ankle hurting
Fatigue
Resp symptoms
What is eBUS-TBNA?
ultra sound guided endobronchial aspirate
