A reevaluation of intrathoracic lymphadenopathy in sarcoidosis

Bein, ME; Putman, Charles E.; McLoud, TC; Mink, JH

doi:10.2214/ajr.131.3.409

Cited by 54 publications

(26 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recent trials of EUS-FNA in sarcoidosis showed a diagnostic value of 82% [13], sensitivity of 89-100% and specificity of 94-96% [24,25]. Lymphadenopathies in sarcoidosis are typically hilar, and involvement of right paratracheal and aorto-pulmonary window lymph nodes is common (70-76%) [26]. EBUS-TBNA is able to sample stations that may be difficult to reach by mediastinoscopy, such as hilar nodes and posterior carinal nodes.…”

Section: Ebus-tbna In Sarcoidosis Diagnosismentioning

confidence: 99%

Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis

Wong¹,

Yasufuku²,

Nakajima³

et al. 2007

European Respiratory Journal

233

204

View full text Add to dashboard Cite

A diagnosis of sarcoidosis should be substantiated by pathological means in order to thoroughly exclude other diseases. The role of real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of sarcoidosis has not been reported. The purpose of the present study is to evaluate the diagnostic yield of EBUS-TBNA in demonstrating the pathological features of sarcoidosis.In total, 65 patients with suspected sarcoidosis, with enlarged hilar or mediastinal lymph nodes on computed tomography, were included in the study. Patients with a suspected or known malignancy or previously established diagnosis of sarcoidosis were excluded. Convex probe endobronchial ultrasonography integrated with a separate working channel was used for EBUS-TBNA. Surgical methods were performed in those in whom no granulomas were detected by EBUS-TBNA. Patients were followed up clinically.EBUS-TBNA was performed on a total of 77 lymph node stations in 65 patients. A final diagnosis of sarcoidosis was made for 61 (93.8%) of the patients. The remaining four patients were diagnosed as having Wegener's granulomatosis (n51) or indefinite (n53). In patients with a final diagnosis of sarcoidosis, EBUS-TBNA demonstrated noncaseating epithelioid cell granulomas in 56 (91.8%) of the patients. No complications were reported.Endobronchial ultrasound-guided transbronchial needle aspiration proved to be a safe procedure with a high yield for the diagnoses of sarcoidosis.

show abstract

Section: Ebus-tbna In Sarcoidosis Diagnosismentioning

confidence: 99%

Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis

Wong¹,

Yasufuku²,

Nakajima³

et al. 2007

European Respiratory Journal

233

204

View full text Add to dashboard Cite

show abstract

“…Most importantly, the radiological presentation was very unusual for sarcoidosis, in spite of a typical histopathology, and in the absence of any clinical symptoms, the diagnosis of sarcoidosis should not have been made. In sarcoidosis, thoracic lymphadenopathy is nearly always usual and, as described by several groups [17,18], left and right hilar lymphadenopathy are observed in 97% of cases. The absence of bilateral hilar lymphadenopathy, with only mediastinal lymphadenopathy appearing in any thorax imaging, is very unusual for sarcoidosis and therefore needs an appropriate search for alternative diagnoses.…”

Section: Discussionmentioning

confidence: 92%

“…Thus, the first condition to diagnose sarcoidosis is to meet a typical or consistent clinical and radiological presentation. While some typical manifestations, such as Löfgren's syndrome [6], Heerfordt's syndrome, and bilateral hilar lymphadenopathy in a patient with uveitis or no clinical manifestation [17,18], are easy to identify. It may be more difficult to specify whether or not other manifestations may be either typical or inconsistent.…”

Section: Discussionmentioning

confidence: 99%

Management of sarcoidosis in clinical practice

et al. 2016

View full text Add to dashboard Cite

Sarcoidosis is a systemic disease of unknown cause with very diverse presentation, outcome, severity and need for treatments. While some presentations may be very typical, for many patients, the presentation is nonspecific, with shared associations with other diseases at times being by far more frequent or misleading, which can be a cause of significant delay and often several consultations before a diagnosis of sarcoidosis can be confirmed. This is particularly the case when pulmonary manifestations are in the forefront. The diagnosis relies on three well-known criteria. In clinical practice, these criteria are not easily implemented, particularly by physicians without expertise in sarcoidosis, which can lead to a risk of either under-or over-diagnosis. Qualifying the presentation according to sarcoidosis diagnosis is essential. However, it is often not easy to classify the presentation as typical versus compatible or compatible versus inconsistent. Further investigations are needed before any other hypothesis is to be considered. It is important to detect events and to determine whether or not they are indicative of a flare of sarcoidosis. Eventually, treatment needs to be related to the correct indications. The evaluation of the efficacy and safety of treatments is crucial. To address such issues, we present five emblematic cases that illustrate this. @ERSpublications Showing emblematic cases is the best way to illustrate the multiple conditions to deal with for managing sarcoidosis http://ow.ly/10A5Yv

show abstract

“…In patients with thoracic lymphadenopathy, BHL is present in over 95% of cases, often associated with enlargement of right paratracheal and aortic-pulmonic window lymph nodes (more than 70% of cases with thoracic lymphadenopathy). Subcarinal (21%), anterior mediastinal (16%) and posterior mediastinal (2%) involvement are less frequent [6]. The presence of lone paratracheal, subcarinal or mediastinal enlarged lymph nodes without BHL is exceptional [6], as is unilateral hilar lymphadenopathy, and should raise the possibility of an alternative diagnosis (i.e.…”

Section: Radiographic Featuresmentioning

confidence: 99%

“…Subcarinal (21%), anterior mediastinal (16%) and posterior mediastinal (2%) involvement are less frequent [6]. The presence of lone paratracheal, subcarinal or mediastinal enlarged lymph nodes without BHL is exceptional [6], as is unilateral hilar lymphadenopathy, and should raise the possibility of an alternative diagnosis (i.e. infection including tuberculosis or histoplasmosis, lymphoma, or bronchogenic or extra-thoracic carcinoma).…”

Section: Radiographic Featuresmentioning

confidence: 99%

Imaging of sarcoidosis of the airways and lung parenchyma and correlation with lung function

et al. 2012

View full text Add to dashboard Cite

Imaging has a prominent role in the assessment of sarcoidosis diagnosis and outcome, which are extremely variable. Chest radiography staging helps predict the probability of spontaneous remission, and stage IV is associated with higher mortality. However, the reproducibility of reading is poor and changes in radiography and lung function are inconsistently correlated, which may be problematic for the monitoring of disease and treatment response. Chest computed tomography (CT) makes a great diagnostic contribution in difficult cases. Bilateral hilar lymphadenopathy with peri-lymphatic micronodular pattern is highly specific for sarcoidosis. CT is important for the investigation of pulmonary complications, including aspergilloma and pulmonary hypertension. CT improves the yield of bronchoscopy for obtaining a positive endobronchial or transbronchial biopsy. CT findings may also discriminate between active inflammation and irreversible fibrosis, with occasional influence on therapeutic decisions. Three CT patterns of fibrotic sarcoidosis are identified, with different functional profiles: predominant bronchial distortion is associated with obstruction; honeycombing is associated with restriction and lower diffusing capacity of the lung for carbon monoxide; whereas functional impairment is relatively minor with linear pattern. The clinical impact of correlations between CT severity scores and functional impairment is uncertain, except for its utility elucidating the mechanisms of airflow limitation, which include bronchial distortion, peribronchovascular thickening, air-trapping and bronchial compression by lymphadenopathy.

show abstract

A reevaluation of intrathoracic lymphadenopathy in sarcoidosis

Cited by 54 publications

References 0 publications

Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis

Endobronchial ultrasound: new insight for the diagnosis of sarcoidosis

Management of sarcoidosis in clinical practice

Imaging of sarcoidosis of the airways and lung parenchyma and correlation with lung function

Contact Info

Product

Resources

About