Pulmonary sarcoidosis with an alveolar radiographic pattern.

Abstract

Thirty-three cases of sarcoidosis (4.4% of 746 patients) showed an alveolar radiological pattern. A study of pulmonary function was carried out in 25 patients and compared with that of 46 patients with the interstitial radiological type of sarcoidosis. Twenty-two cases have been followed up from one to six years after the initial examination. The radiographic lesions were most often bilateral and included nodules greater than 15 mm with ill-defined margins or diffuse, infiltrative, non-retractile opacities with fluffy margins. Bilateral mediastinal lymph nodes were present in 27 patients. In 20 patients an associated reticulation was found on radiography. In four patients an open lung biopsy was done. The granulomatous nodules were identical to those found in other forms of sarcoidosis, although they were more confluent in the affected areas. Clinical and functional findings did not differ from those in the more common forms of sarcoidosis. Alveolar sarcoidosis has a sudden course. The alveolar radiological patterns always disappeared, with or without steroid treatment, while reticular patterns persisted in four patients. Rapid radiological changes were observed. Some functional abnormalities persisted in cases that were followed. It is concluded that alveolar sarcoidosis is a distinct acute form of sarcoidosis.Sarcoid granulomas are found in the alveolar septa and less frequently in the walls of bronchi, pulmonary arteries, and veins.' The radiological findings in pulmonary sarcoidosis may typically be of one of three types of diffuse interstitial opacities2: reticular, reticulomicronodular, or nodular (nodules less than 5 mm in diameter). Less The TLCO was scaled according to age and height (indicated as TLCO Ht). The static ventilatory mechanics were estimated through the relation between the volume measured at the mouth and the transpulmonary pressure during slow expiration. The following indices were calculated: static expiratory compliance (CL) meas-

Acute alveolar sarcoidosis presenting with hypoxaemic respiratory failure

“…Shigematsu et al 15 documented the presence of bilateral mediastinal lymphadenopathy in all 20 (100%) patients of alveolar sarcoidosis. This was further supported by Battesti et al ,13 who in their series of 33 patients with alveolar sarcoidosis observed the presence of bilateral mediastinal lymphadenopathy in 27 (81.81%) patients. However, Sahn et al ,6 in their description of the only other patient with alveolar sarcoidosis presenting with acute hypoxaemic respiratory failure, did not observe mediastinal lymphadenopathy.…”

“…While reviewing 746 patients with pulmonary sarcoidosis from France,13 the authors detected 33 (4.4%) patients with this specific radiological presentation. They observed that alveolar sarcoidosis occurred predominantly in men (23/33, 69.6%) and in the younger age group (mean age=28.4+1.85 years).…”

“…Alveolar sarcoidosis is estimated to occur in 1–4.4% patients,5 13 14 with only one study15 taking a much broader definition, suggesting that this radiological pattern can occur in up to 20% of patients with pulmonary sarcoidosis. This radiological pattern in sarcoidosis was highlighted by Felson16 to describe opacities of the infiltrative type, non-retractile, with ill-defined margins and sometimes an air bronchograms, or nodules with ill-defined limits and diameters greater than 15 mm.…”

“…Battesti et al 13 performed lung biopsies in 4 of 33 patients and also thought that this occurred due to the collapse of alveolar walls by the confluence of interstitial granulomas. In contrast, Sahn et al 6 who presented the only other patient of alveolar sarcoidosis with acute hypoxaemic respiratory failure observed on biopsy that the alveoli were invaded by mononuclear cells, which was a non–specific reaction to the sarcoid granuloma in the interstitium.…”

“…Ten of these 15 patients experienced spontaneous radiological resolution within nine months 15. Of the 33 patients from France,13 22 were followed up; 15 of them received therapy with corticosteroids while 7 remained untreated. All 15 patients had rapid radiological resolution of the alveolar pattern within a few weeks and of the 7 untreated patients, 6 had spontaneous radiological clearance.…”