Abstract
Severe thoracic sarcoidosis includes manifestations with significant clinical and functional impairment and a risk of mortality. Severe thoracic sarcoidosis can take on various clinical presentations and is associated with increased morbidity. The purpose of this article was to describe the CT findings in severe thoracic sarcoidosis and to explain some of their mechanisms. Subacute respiratory insufficiency is a rare and early complication due to a high profusion of pulmonary lesions. Chronic respiratory insufficiency due to pulmonary fibrosis is a frequent and late complication. Three main CT patterns are identified: bronchial distortion, honeycombing and linear opacities. CT can be helpful in diagnosing some mechanisms of central airway obstruction such as bronchial distortion due to pulmonary fibrosis or an extrinsic bronchial compression by enlarged lymph nodes. An intrinsic narrowing of the bronchial wall by endobronchial granulomatous lesions may be suggested by CT when it shows evidence of bronchial mural thickening. Pulmonary hypertension usually occurs in patients with end-stage pulmonary disease and is related to fibrotic destruction of the distal capillary bed and to the resultant chronic hypoxemia. Several other mechanisms may contribute to the development of pulmonary hypertension including extrinsic compression of major pulmonary arteries by enlarged lymph nodes and secondary pulmonary veno-occlusive disease. Aspergilloma colonization of a cavity is the main cause of hemoptysis in sarcoidosis. Other rare causes are bronchiesctasis, necrotizing bronchial aspergillosis, semi-invasive pulmonary aspergillosis, erosion of a pulmonary artery due to a necrotic sarcoidosis lesion, necrosis of parenchymal sarcoidosis lesions and specific endobronchial macroscopic lesions.
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References
Hunninghake GW, Crystal RG (1981) Pulmonary sarcoidosis: a disorder mediated by excess helper T-lymphocyte activity at sites of disease activity. N Engl J Med 305:429–434
Muller NL, Mawson JB, Mathieson JR, Abboud R, Ostrow DN, Champion P (1989) Sarcoidosis: correlation of extent of disease at CT with clinical, functional, and radiographic findings. Radiology 171:613–618
Remy-Jardin M, Giraud F, Remy J, Wattinne L, Wallaert B, Duhamel A (1994) Pulmonary sarcoidosis: role of CT in the evaluation of disease activity and functional impairment and in prognosis assessment. Radiology 191:675–680
Drent M, De Vries J, Lenters M, Lamers RJ, Rothkranz-Kos S, Wouters EF, van Dieijen-Visser MP, Verschakelen JA (2003) Sarcoidosis: assessment of disease severity using HRCT. Eur Radiol 13:2462–2471
Viskum K, Vestbo J (1993) Vital prognosis in intrathoracic sarcoidosis with special reference to pulmonary function and radiological stage. Eur Respir J 6:349–353
Abehsera M, Valeyre D, Grenier P, Jaillet H, Battesti JP, Brauner MW (2000) Sarcoidosis with pulmonary fibrosis: CT patterns and correlation with pulmonary function. Am J Roentgenol 174:1751–1757
Lavergne F, Clerici C, Sadoun D, Brauner M, Battesti JP, Valeyre D (1999) Airway obstruction in bronchial sarcoidosis: outcome with treatment. Chest 116:1194–1199
Lenique F, Brauner MW, Grenier P, Battesti JP, Loiseau A, Valeyre D (1995) CT assessment of bronchi in sarcoidosis: endoscopic and pathologic correlations. Radiology 194:419–423
Gleeson FV, Traill ZC, Hansell DM (1996) Evidence of expiratory CT scans of small-airway obstruction in sarcoidosis. Am J Roentgenol 166:1052–1054
Tan RT, Kuzo R, Goodman LR, Siegel R, Haasler GB, Presberg KW (1998) Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Chest 113:1250–1256
Ng CS, Wells AU, Padley SP (1999) A CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter. J Thorac Imaging 14:270–278
Battesti JP, Georges R, Basset F, Saumon G (1978) Chronic cor pulmonale in pulmonary sarcoidosis. Thorax 33:76–84
Damuth TE, Bower JS, Cho K, Dantzker DR (1980) Major pulmonary artery stenosis causing pulmonary hypertension in sarcoidosis. Chest 78:888–891
Smith LJ, Lawrence JB, Katzenstein AA (1983) Vascular sarcoidosis: a rare cause of pulmonary hypertension. Am J Med Sci 285:38–44
Hoffstein V, Ranganathan N, Mullen JB (1986) Sarcoidosis simulating pulmonary veno-occlusive disease. Am Rev Respir Dis 134:809–811
Corsello BF, Lohaus GH, Funahashi A (1983) Endobronchial mass lesion due to sarcoidosis: complete resolution with corticosteroids. Thorax 38:157–158
Olsson T, Björnstad-Pettersen H, Sternberg NL (1979) Bronchostenosis due to sarcoidosis: a cause of atelectasis and airway obstruction simulating pulmonary neoplasm and chronic obstructive pulmonary disease. Chest 75:663–666
Hadfield JW, Page RL, Flower CD, Stark JE (1982) Localised airway narrowing in sarcoidosis. Thorax 37:443–447
Brandstetter RD, Hansen DE, Jarowski CI, King T, Barletta A (1981) Superior vena cava syndrome as the initial clinical manifestation of sarcoidosis. Heart Lung 10:101–104
Wollschlager C, Khan F (1984) Aspergillomas complicating sarcoidosis. A prospective study in 100 patients. Chest 86:585–588
Rubinstein I, Solomon A, Baum GL, Hiss Y (1985) Pulmonary sarcoidosis presenting with unusual roentgenographic manifestations. Eur J Respir Dis 67:335–340
Fujimura M, Ishiura Y, Kasahara K, Amemiya T, Myou S, Hayashi Y et al (1998) Necrotizing bronchial aspergillosis as a cause of hemoptysis in sarcoidosis. Am J Med Sci 315:56–58
Franquet T, Muller NL, Gimenez A, Domingo P, Plaza V, Bordes R (2000) Semiinvasive pulmonary aspergillosis in chronic obstructive pulmonary disease: radiologic and pathologic findings in nine patients. Am J Roentgenol 174:51–56
Lemay V, Carette MF, Parrot A, Bazelly B, Grivaux M, Milleron B (1995) Hemoptysis in sarcoidosis. A propos of six cases including four with fatal outcome. Rev Pneumol Clin 51:61–70
Reich JM, Mullooly JP, Johnson RE (1995) Linkage analysis of malignancy-associated sarcoidosis. Chest 107:605–613
Massaguer S, Sanchez M, Castel T (2004) Mediastinal sarcoidosis induced by high-dose alpha-2-interferon therapy in a patient with malignasnt melanoma. Eur Radiol 14:1716–1717
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Hennebicque, AS., Nunes, H., Brillet, PY. et al. CT findings in severe thoracic sarcoidosis. Eur Radiol 15, 23–30 (2005). https://doi.org/10.1007/s00330-004-2480-4
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DOI: https://doi.org/10.1007/s00330-004-2480-4