Sarcoidosis

Question 1

What is Sarcoidosis:

Answer 1

Most commonly affects the lungs

Question 2

Non-caseating granulomas without a fully understood cause

Answer 2

Current thoughts

Chronic beryllium disease-hard to distinguish from sarcoidosis

Question 3

Features suggesting infectious etiology

Answer 3

Question 4

Now have high throughput methods of sequencing bacteria, viruses and fungi.

But studies didn’t identify any single microorganism across sarcoidosis cases, despite taking into account environmental factors

Environmental factors

Answer 4

Like in allergic pneumonitis-smoking helps

Question 5

Sarcoid genetic links

Answer 5

Question 6

Very variable disease in terms of the organs it affects and where it is found

Answer 6

Skin sarcoid more common in african-americans

Question 7

It is possible its a family of disease

Answer 7

Lofgrens disease-bilateral hilar lymphadenopathy

Question 8

Granulomas

Answer 8

In most people can go to resolution but in a few people it can lead to fibrosis

Question 9

Sarcoidosis

Answer 9

Follows a lymphatic distribution. Can see around here the granulomas that follow the bronchovascular bundles. This helps us understand the imaging

Question 10

Yellow circles are where granulomas would be found eg the septum.

Can see nodules are mainly focused around bronchiovascular bundle

Diagnostic algorithms

Answer 10

Soem cases don’t need histology eg in lofgrens syndrome-where have classic lesions of erythema nodosum and bilateral hilar lymphadenopathy

Also look at lungs where egg shell classic distribution

Question 11

Typical imaging patterns

Answer 11

If typical may not need histology as classic distribution eg see these

Question 12

Less common imaging

Answer 12

• Ground glass appearance
• Larger nodes make you think metastatic
• Honey comb seen on right which makes you think fibrotic disease

Question 13

Stages of sarcoidosis:

Answer 13

Stage 4-trachea is being pulled because of the fibrosis. Sarcoid is most prominent in the mid and upper lobes so it pulls up.

Question 14

broad cohort outcomes

Answer 14

Question 15

Issue of scadding staging

Answer 15

Question 16

Diagnosis of sarcoidosis

Answer 16

TB, lymphoma, lympangitis are ddx so if immunosuppressed

Question 17

Diagnosis of stage 1 and 2 and 3 and 4

Answer 17

3 and 4-lavage and expect to find lymphocytosis

Question 18

Progressive lung fibrosis

Answer 18

Remaining 30% is due to cardiac involvement

2005-lot of traction of bronchi

Question 19

Predictors of mortality

Answer 19

-Pulmonary hypertension-this is bad for all types of pulmonary fibrosis

Question 20

Within fibrotic disease

Answer 20

Difficult to know if progressive or stable

Question 21

Measures of disease activity

Answer 21

Question 22

Can we assess reversibility?

Question 23

Monitoring pulmonary sarcoidosis:

Answer 23

Question 24

Danger from sarcoidosis

Answer 24

Question 25

Identify risk stratification

Answer 25

Question 26

Cardiac sarcoid is asymptomatic so anyone with sarcoid should be screened using MRI and PET scan

Answer 26

Question 27

Cardiac sarcoid

Answer 27