Evidence of expiratory CT scans of small-airway obstruction in sarcoidosis.

Gleeson, F V; Traill, Zoë; Hansell, D.M.

doi:10.2214/ajr.166.5.8615240

Cited by 65 publications

(30 citation statements)

References 10 publications

(1 reference statement)

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“…Physiological studies suggested that airflow obstruction located at the level of the small airways may be an early feature of sarcoidosis [139,140]. Supportive evidence, in the form of patchy airtrapping seen on expiratory CT, was first described in three case reports [141] and later confirmed in a larger series [142,143] (fig. 15).…”

Section: Sarcoidosismentioning

confidence: 98%

Small airways diseases: detection and insights with computed tomography

Dm¹

2001

Eur Respir J

146

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Diseases affecting the small airways are difficult to detect by traditional diagnostic tests. Widespread involvement is needed before symptoms and abnormalities on pulmonary function testing or chest radiography become apparent. Obstruction of the bronchioles may be detected indirectly by computed tomography (CT) because regional under-ventilation results in reduced perfusion which in turn is shown as a mosaic attenuation pattern of the lung parenchyma. When there is inflammation of the bronchioles with accompanying exudate, the airways may become directly visible on CT, for example in cases of diffuse panbronchiolitis.Quantification of the various morphological features of small airways disease is possible from CT images and this increased precision has aided investigations of structure/function relationships.An understanding of the pathology and microscopic distribution of disease in relation to the airways allows some prediction of the likely computed tomography appearances in this wide spectrum of conditions, and thus helps to refine the differential diagnosis.

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Section: Sarcoidosismentioning

confidence: 98%

Small airways diseases: detection and insights with computed tomography

Dm¹

2001

Eur Respir J

146

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“…6 without topographic predominance CT scan reveals slightly irregular thickening of the bronchial walls with bronchial lumina narrowing, suggesting that AO is at least partially due to specific bronchial involvement of small airway narrowing by bronchiolar granulomas by showing patchy air trapping (Fig. 11a,b) [9].…”

Section: Airway Obstructionmentioning

confidence: 99%

CT findings in severe thoracic sarcoidosis

et al. 2004

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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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“…of patients [47,50,52,54,91] and may constitute the sole CT evidence of pulmonary sarcoidosis [52,90]. This frequency is probably overestimated by these studies, where the definition of air-trapping was ambiguous.…”

Section: Series: Sarcoidosis From Bench To Bedside H Nunes Et Almentioning

confidence: 96%

“…Minimum projection can provide an additional assessment of these lesions since it is an accurate tool to study proximal airways [33]. Increasing attention has been devoted to airtrapping [23,47,50,52,54,[88][89][90][91]. Mosaic decreased attenuation caused by air-trapping is often obvious on inspiratory images and is enhanced on expiration.…”

Section: Airway Involvementmentioning

confidence: 99%

“…HANSELL et al [50] demonstrated that the extent of reticular pattern was independently associated with several indices of airflow obstruction, including FEV1, FEV1/FVC, maximal expiratory flow (MEF) at 25% above residual volume (RV), MEF at 50% above RV and RV/total lung capacity (TLC). Air-trapping is associated with evidence of small-airway obstruction including maximal expiratory flow between of FVC, RV and/or RV/TLC in some studies [47,52,90], whereas in others it only contributes little to airflow obstruction [50,54].…”

Section: Series: Sarcoidosis From Bench To Bedside H Nunes Et Almentioning

confidence: 99%

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

et al. 2012

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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.

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Evidence of expiratory CT scans of small-airway obstruction in sarcoidosis.

Cited by 65 publications

References 10 publications

Small airways diseases: detection and insights with computed tomography

Small airways diseases: detection and insights with computed tomography

CT findings in severe thoracic sarcoidosis

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

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