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Sarcoidosis Effects On The Lung Tissue As Seen On Radiographs With Several X-Ray Representations

Updated on February 6, 2014

X-Ray: Major Diagnostic procedure

Source

Introduction

There are some cells involved in inflammatory processes. These specific inflammatory cells are called granulomas. These granulomas form nodules and settle in several organs. Though they can settle in any organ, the commonest are usually the Lungs and Lymph nodes. In most cases Sarcoidosis is asymptomatic but when chronic, it can cause lung scarring and then respiratory failure and even death.

It has been noticed that more than 65% of patients with this syndrome have no symptoms and in most of them, the disease gradually disappears, but as for the remaining 35%, they end up suffering from lung abnormalities. The following x-rays will give a diagnostic evaluation on how to detect Sarcoidosis.

Sarcoidosis On Chest X-Ray

 Besnier-Boeck disease or Besnier-Boeck-Schaumann disease, is a syndrome involving abnormal collections of chronic inflammatory cells (granulomas) that can form as nodules in multiple organs
Besnier-Boeck disease or Besnier-Boeck-Schaumann disease, is a syndrome involving abnormal collections of chronic inflammatory cells (granulomas) that can form as nodules in multiple organs | Source
The granulomas are most often located in the lungs or the lymph nodes, but any organ can be affected. Onset is usually gradual. Sarcoidosis may be asymptomatic or chronic.
The granulomas are most often located in the lungs or the lymph nodes, but any organ can be affected. Onset is usually gradual. Sarcoidosis may be asymptomatic or chronic. | Source
It commonly improves or clears up spontaneously. More than two-thirds of people with lung sarcoidosis have no symptoms after 9 years. About 50% have relapses. About 10% develop serious disability
It commonly improves or clears up spontaneously. More than two-thirds of people with lung sarcoidosis have no symptoms after 9 years. About 50% have relapses. About 10% develop serious disability | Source
Lung scarring or infection may lead to respiratory failure and death.[1] In chronic cases, symptoms may fluctuate over many years
Lung scarring or infection may lead to respiratory failure and death.[1] In chronic cases, symptoms may fluctuate over many years | Source
Sarcoidosis seems to be caused by an immune reaction to an infection that continues after the cause of the infection is gone
Sarcoidosis seems to be caused by an immune reaction to an infection that continues after the cause of the infection is gone | Source
Diagnosis of sarcoidosis is often a matter of exclusion. To exclude sarcoidosis in a case presenting with pulmonary symptoms might involve chest X-ray, CT scan of chest, PET scan, CT-guided biopsy, mediastinoscopy, open lung biopsy
Diagnosis of sarcoidosis is often a matter of exclusion. To exclude sarcoidosis in a case presenting with pulmonary symptoms might involve chest X-ray, CT scan of chest, PET scan, CT-guided biopsy, mediastinoscopy, open lung biopsy | Source
bronchoscopy with biopsy, endobronchial ultrasound and endoscopic ultrasound with FNA of mediastinal lymph nodes(EBUS FNA). Tissue from biopsy of lymph nodes is subjected to both flow cytometry to rule out cancer and special stains
bronchoscopy with biopsy, endobronchial ultrasound and endoscopic ultrasound with FNA of mediastinal lymph nodes(EBUS FNA). Tissue from biopsy of lymph nodes is subjected to both flow cytometry to rule out cancer and special stains | Source
 to rule out microorganisms and fungi. Angiotensin-converting enzyme blood levels are used in diagnosis and monitoring of sarcoidosis
to rule out microorganisms and fungi. Angiotensin-converting enzyme blood levels are used in diagnosis and monitoring of sarcoidosis | Source
Differential diagnosis includes metastatic disease, lymphoma, septic emboli, rheumatoid nodules, Wegener's granulomatosis, varicella infection, and atypical infections, such as Mycobacterium avium complex, cytomegalovirus, and cryptococci
Differential diagnosis includes metastatic disease, lymphoma, septic emboli, rheumatoid nodules, Wegener's granulomatosis, varicella infection, and atypical infections, such as Mycobacterium avium complex, cytomegalovirus, and cryptococci | Source
Sarcoidosis is confused most commonly with neoplastic diseases, such as lymphoma, or with disorders characterized also by a mononuclear cell granulomatous inflammatory process, such as the mycobacterial and fungal disorders
Sarcoidosis is confused most commonly with neoplastic diseases, such as lymphoma, or with disorders characterized also by a mononuclear cell granulomatous inflammatory process, such as the mycobacterial and fungal disorders | Source
Because of the wide range of possible manifestations, the investigations to confirm diagnosis may involve many organs and methods, depending on initial presentation.
Because of the wide range of possible manifestations, the investigations to confirm diagnosis may involve many organs and methods, depending on initial presentation. | Source
Very often, sarcoidosis presents as a restrictive disease of the lungs, causing a decrease in lung volume and decreased compliance (the ability to stretch); hence, chest X-ray and other methods are used to assess the severity or rule out pulmonary di
Very often, sarcoidosis presents as a restrictive disease of the lungs, causing a decrease in lung volume and decreased compliance (the ability to stretch); hence, chest X-ray and other methods are used to assess the severity or rule out pulmonary di | Source
The disease typically limits the amount of air drawn into the lungs, but produces higher than normal expiratory flow ratios. Obstructive lung changes, causing a decrease in the amount of air that can be exhaled, may occur when enlarged lymph nodes in
The disease typically limits the amount of air drawn into the lungs, but produces higher than normal expiratory flow ratios. Obstructive lung changes, causing a decrease in the amount of air that can be exhaled, may occur when enlarged lymph nodes in | Source
Although patients with stage 1 X-rays tend to have the acute or subacute, reversible form of the disease, those with stages 2 and 3 often have the chronic, progressive disease; these patterns do not represent consecutive "stages" of sarcoidosis.
Although patients with stage 1 X-rays tend to have the acute or subacute, reversible form of the disease, those with stages 2 and 3 often have the chronic, progressive disease; these patterns do not represent consecutive "stages" of sarcoidosis. | Source
Thus, except for epidemiologic purposes, this X-ray categorization is mostly of historic interest
Thus, except for epidemiologic purposes, this X-ray categorization is mostly of historic interest | Source
Investigations to assess involvement of other organs frequently involve electrocardiogram, ocular examination by an ophthalmologist, liver function tests, renal function tests, serum calcium, and 24-hour urine calcium.
Investigations to assess involvement of other organs frequently involve electrocardiogram, ocular examination by an ophthalmologist, liver function tests, renal function tests, serum calcium, and 24-hour urine calcium. | Source
In sarcoidosis presenting in the Caucasian population, hilar adenopathy and erythema nodosum are the most common initial symptoms. In this population, a biopsy of the gastrocnemius muscle is a useful tool in correctly diagnosing the patient.
In sarcoidosis presenting in the Caucasian population, hilar adenopathy and erythema nodosum are the most common initial symptoms. In this population, a biopsy of the gastrocnemius muscle is a useful tool in correctly diagnosing the patient. | Source
The presence of a noncaseating epithelioid granuloma in a gastrocnemius specimen is definitive evidence of sarcoidosis, as other tuberculoid and fungal diseases extremely rarely present histologically in this muscle.
The presence of a noncaseating epithelioid granuloma in a gastrocnemius specimen is definitive evidence of sarcoidosis, as other tuberculoid and fungal diseases extremely rarely present histologically in this muscle. | Source
In female patients, sarcoidosis is significantly associated with hypothyroidism, hyperthyroidism and other thyroid diseases, hence close surveillance of thyroid function is recommended
In female patients, sarcoidosis is significantly associated with hypothyroidism, hyperthyroidism and other thyroid diseases, hence close surveillance of thyroid function is recommended | Source
Common neurosarcoid locations noted on MR: (1) enveloping the infundibulum and extending into the parasellar region; (2) contiguous disease wrapping the inferior frontal lobes; and (3) synchronous lesions of the superior vermis and 4th ventricle chor
Common neurosarcoid locations noted on MR: (1) enveloping the infundibulum and extending into the parasellar region; (2) contiguous disease wrapping the inferior frontal lobes; and (3) synchronous lesions of the superior vermis and 4th ventricle chor | Source
MR demonstrates significant thickening and mild enhancement of the optic chiasm and T2 hyperintensity in both optic tracts and hypothalamus. T1WI with contrast MR imaging may show diffuse dural and leptomeningeal thickening with enhancement.
MR demonstrates significant thickening and mild enhancement of the optic chiasm and T2 hyperintensity in both optic tracts and hypothalamus. T1WI with contrast MR imaging may show diffuse dural and leptomeningeal thickening with enhancement. | Source
The disease can remit spontaneously or become chronic, with exacerbations and remissions. In some patients, it can progress to pulmonary fibrosis and death.
The disease can remit spontaneously or become chronic, with exacerbations and remissions. In some patients, it can progress to pulmonary fibrosis and death. | Source
About half of the cases resolve without treatment or can be cured within 12–36 months, and most within five years. Some cases persist several decades
About half of the cases resolve without treatment or can be cured within 12–36 months, and most within five years. Some cases persist several decades | Source
When the heart is involved, the prognosis is poor. Patients with sarcoidosis appear to be at significantly increased risk for cancer, in particular lung cancer, malignant lymphomas
When the heart is involved, the prognosis is poor. Patients with sarcoidosis appear to be at significantly increased risk for cancer, in particular lung cancer, malignant lymphomas | Source
and cancer in other organs known to be affected in sarcoidosis.[55] In sarcoidosis-lymphoma syndrome, sarcoidosis is followed by the development of a lymphoproliferative disorder such as non-Hodgkin lymphoma
and cancer in other organs known to be affected in sarcoidosis.[55] In sarcoidosis-lymphoma syndrome, sarcoidosis is followed by the development of a lymphoproliferative disorder such as non-Hodgkin lymphoma | Source
This may be attributed to the underlying immunological abnormalities that occur during the sarcoidosis disease process. Sarcoidosis can also follow cancer or occur concurrently with cancer
This may be attributed to the underlying immunological abnormalities that occur during the sarcoidosis disease process. Sarcoidosis can also follow cancer or occur concurrently with cancer | Source
There have been reports of hairy cell leukemia, acute myeloid leukemia, and acute myeloblastic leukemia  associated with sarcoidosis.
There have been reports of hairy cell leukemia, acute myeloid leukemia, and acute myeloblastic leukemia associated with sarcoidosis. | Source
Sarcoidosis most commonly affects young adults of both sexes, although studies have reported more cases in females. Incidence is highest for individuals younger than 40 and peaks in the age-group from 20 to 29 years; a second peak is observed for wom
Sarcoidosis most commonly affects young adults of both sexes, although studies have reported more cases in females. Incidence is highest for individuals younger than 40 and peaks in the age-group from 20 to 29 years; a second peak is observed for wom | Source
Sarcoidosis occurs throughout the world in all races with an average incidence of 16.5 per 100,000 in men and 19 per 100,000 in women. The disease is most prevalent in Northern European countries and the highest annual incidence of 60 per 100,000 is
Sarcoidosis occurs throughout the world in all races with an average incidence of 16.5 per 100,000 in men and 19 per 100,000 in women. The disease is most prevalent in Northern European countries and the highest annual incidence of 60 per 100,000 is | Source

References

1. All X-ray photos here are from DFM E-Group, in the photo and X-ray section.

2. Notes and explanations: Wikipedia, Essentials of Clinical Medicine by Kumar and Clark's, Medicinenet and Mayor's Clinic.

© 2014 Funom Theophilus Makama

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