Presentation Transcript
Pulmonary Sarcoidosis:Pulmonary Sarcoidosis Yogin Patel
Radiology Elective
April 6th 2004
Agenda:Agenda Clinical presentation
Evaluation
Radiographic Findings
Discussion
Clinical Presentation:Clinical Presentation History
24 YO AA M with 2 weeks of pleuritic chest pain
Other Symptoms
Fever, anorexia, arthralgias, DOE, cough, hemoptysis
Physical Exam
Neuro: CN palsy
Optho: Uveitis
Card: Cardiomyopathy, pericarditis
GI: Hepatic granulomas, cholestasis
Lungs: Restriction
Renal: Nephrolithiasis
Derm: Erythematous nodules
Heme: Anemia, thrombocytopenia, leukopenia
Radiographic Findings:Radiographic Findings
Evaluation:Evaluation Routine labs – Primarily useless
Lab abnormalities associated with areas of involvement (↑ Alk Phos with hepatic involvement)
Kveim Test
Angiotensin Converting Enzyme elevation
ACE is secreted by granulomas and may be present in serum, CSF, BAL washings
Biopsy
Noncaseating granulomas
Radiographic Findings:Radiographic Findings
Radiographic Findings:Radiographic Findings
Radiographic Findings:Radiographic Findings
Pulmonary Sarcoidosis:Pulmonary Sarcoidosis
Treatment:Treatment Treat?
Symptomatic Therapy
NSAIDS
Corticosteroid Therapy
Prednisone
Non-steroid Therapy
Methotrexate
Hydroxychloroquinine
References:References Shorr, Andrew. “Sarcoidosis”. eMedicine http://www.emedicine.com/MED/topic2063.htm
Rockoff SD. “Unusual manifestations of thoracic sarcoidosis”. AJR 1985 144: 513-528 (Review article)
Harris, Hugh and Priscilla Sarinas. “Sarcoidosis”. Best Practice of Medicine. June 2001. http://merck.praxis.md/index.asp?page=bpm_brief&article_id=BPM01PU06
Williams, Scott. Sarcoidosis. http://www.auntminnie.com/ScottWilliamsMD2/Chest/Autoimmune/Sarcoid/Sarcoid.htm