Sarcoidosis Flashcards
Sarcoidosis–essentials of diagnosis
- symptoms related to lung, skin, eyes, peripheral servers, liver, kidney, heart, other tissues
- noncaseating granulomas in biopsy specimen
- Exclusion of other granulomatous disorders
General considerations–sarcoidosis
- systemic disease of unknown etiology
- 90% have granulomatous inflammation of lung
- highest in N. American blacks and N. european whites
- most commonly black women
- Onset= 3-4th decade
Sarcoidosis signs and symptoms
- malaise, fever, dyspnea
- skin–erythema nodosum, lupus penio
- iritis
- peripheral neuropathy
- arthritis
- cardiomyopathy
- some are asymptomatic but have abnormal findings like bilateral hilar and right paratracheal lymphadenopathy on chest x-ray
Sarcoidosis PE
- atypical of interstitial lung disease in that crackles are UNCOMMON
- parotid gland enlargement, hepatosplenomegaly, lymphadenopathy
Lab findings for sarcoidosis
- leukopenia
- high ESR and hypercalcemia (5%)
- high ACE (40-80%)–but never diagnostic!
- airflow obstruction but restrictive changes with decreased lung volumes and diffusing capacity more common
- Skin test anergy present in 70%
- ECG: conduction disturbance and dysarythmias
Sarcoidosis imaging
-variable
Radiographic stage I of sarcoidosis
bilateral lymphadenopathy alone
Radiographic stage II of sarcoidosis
hilar adenopathy AND parenchymal involvment
Radiographic stage III of sarcoidosis
Parenchymal involvement alone
Parenchymal involvement of sarcoidosis on radiograph looks like?
- Diffuse reticular infiltrates but focal infiltrates, acinar shadows, nodules and rarely cavitation seen
- pleural effusion seen in less than 10%
Radiographic stage IV of sarcoidosis
Advanced fibrotic changes principally in upper lobes
Sarcoidosis special exams
- requires histologic demonstration of noncaseating granulomas in biopsies with other typical associated findings
- Other granulomatous diseases (berylliosis, Tb, fungal infxns must be excluded)
Easily accessible sites for biopsy to dx sarcoidosis
- palpable lymph nodes, skin lesions, salivary glands
- likely to be positive
*Transbronchial biopsy has high yield as well, esp in those with parenchymal involvement on X ray
When to use biopsy and when not to for sarcoidosis
- May not need it for stage I if imaging and situation favors Dx (young black woman with erythema nodosum)
- Biopsy essential when imaging and clinical suggest possibility of something else like lymphoma
Bronchioalveolar lavage in sarcoidosis shows
- Increase in lymphocytes
- High CD4/CD8 ratio
- Bronchoalveolar lavage does NOT establish Dx but may be useful in following activity of sarcoidosis in selected pts
