Images in Clinical Medicine
Nodular Sarcoidosis
N Engl J Med 2002; 346:1970June 20, 2002
- Article
Figure 1 A 24-year-old woman was evaluated because of a three-month history of cough, dyspnea, and weight loss. A chest radiograph revealed nodular pulmonary densities of various sizes and with ill-defined margins (Panel A). The pH was 7.44, the partial pressure of arterial carbon dioxide was 34 mm Hg, and the partial pressure of arterial oxygen was 93 mm Hg while she was breathing ambient air. Lung-biopsy specimens obtained by fiberoptic bronchoscopy revealed noncaseating granulomas with giant cells consistent with a diagnosis of sarcoidosis (Panel B; hematoxylin, phloxine, and safranin O, ×100). The patient was lost to follow-up for six months and received no treatment. When she was seen again, her symptoms had resolved. A chest radiograph showed almost complete disappearance of the nodular densities (Panel C). Spirometry revealed a vital capacity of 2.7 liters (71 percent of the predicted value), a forced expiratory volume in one second of 2.1 liters (72 percent of the predicted value), and a ratio of the forced expiratory volume in one second to forced vital capacity of 78 percent, indicative of a mild restrictive ventilatory defect.
Lung nodules with a “fluffy” or “snowball” appearance are typical of nodular sarcoidosis, although they are uncommon as a presentation of sarcoidosis in general. The nodules may resemble metastatic neoplasia, but despite their often dramatic radiographic appearance, they frequently have a benign clinical course. Spontaneous resolution is common. Pulmonary-function tests usually provide evidence of restrictive disease, which may persist or worsen despite clinical and radiographic improvement.
Paul C. McCullough, M.D.
Ridgewood, NJ 07450-2423Ann E. McCullough, M.D.
Mayo Clinic Scottsdale, Scottsdale, AZ 85259-5404- Citing Articles (2)
Citing Articles
1
Subramanian Malaisamy, Bhavinkumar Dalal, Christian Bimenyuy, Ayman O. Soubani. (2009) The Clinical and Radiologic Features of Nodular Pulmonary Sarcoidosis. Lung 187:1, 9-15
CrossRef2
G. Armengol, J. Bernet, L. Lahaxe, H. Lévesque, I. Marie. (2009) Un mode de révélation inhabituel de la sarcoïdose. La Revue de Médecine Interne 30:1, 53-57
CrossRef
