Respiratory: Sarcoidosis

Question 1

What are the causes of bilateral lymphadenopathy?

Answer 1

Sarcoidosis

TB

Lymphoma

Question 2

How does sarcoidosis appear on HRCT?

Answer 2

Perilymphatic nodularity

LN enlargement

End stage = pulmonary fibrosis (honeycombing)

Question 3

Outline the pathophysiology of sarcoidosis

Answer 3

Noncaseating granulomas (NCGs) in affected organ tissues - with unknown cause

Common in women 20-40yrs old, more common and severe in African-carribeans than Caucasians

Question 4

What is the aetiology of sarcoidosis?

Answer 4

Unknown

Question 5

What are the signs and symptoms of sarcoidosis?

Answer 5

Asymptomatic

Fever

Swollen tissue = fingers

Pulmonary = dyspnea on exertion, cough, chest pain, crackles, exertional O2 desaturation

Löfgren syndrome = fever, bilateral hilar lymphadenopathy, and polyarthralgias

Erythema nodosum

Lupus pernio (the most specific associated cutaneous lesion)

Opthalmic sarcoidosis - uveitis

Hepatosplenomegaly

Enlarged LN

Abnormal vit D reg - macrophages secrete vit D = more Ca absorbed from gut = high Ca

Question 6

What investigations should be performed if sarcoidosis is suspected?

Answer 6

Bloods = increased Ca2+ (normal does not rule out), increased ESR, lymphopenia, increased LFTs, ACE levels (elevated or normal)

CXR = bilateral hilar lymphadenopathy

HRCT thorax (use when looking at lung parenchyma)

◦ Perilymphatic nodularity

◦ End stage = pulmonary fibrosis (honeycombing)

Tissue biopsy = non-caseating granulomas

◦ Endobronchial US (EBUS)

◦ Medistinum biopsy Spirometry

Question 7

How is sarcoidosis managed?

Answer 7

Pts with BHL = don’t need treatment, spontaneous remission

Acute = bed rest, NSAIDs

Treat =

◦ Persistent progressive pulmonary disease

◦ Disfiguring skin disease = steroid

◦ End organ involvement

◦ Persistent hypercalcaemia

◦ Uveitis

Question 8

What is erythema nodosum?

Answer 8

Crops of bilateral deep tender nodules, pretibial

Overlying skin shiny, red

Onset acute with arthralgia, malaise, oedema

2-3days lesions flatten and have bruised appearance may last day-weeks

Causes =

◦ Idiopathic

◦ Bacterial infection

◦ Sarcoidosis

Treat = NSAIDs

Question 9

How is sarcoidosis staged?

Answer 9

CXR

0. No abnormailites. 5-10%
1. Lymphodenopathy - 50%
2. Lymphodenopathy - pulmonary infiltration (parenchymal involvement) - 25-30%
3. Pulmonary infiltration - 10-12%
4. Fibrosis - 5%

Question 10

How does sarcoidosis appear on CXR?

Answer 10