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Weekly Chest CasesArchive of Old Cases

Case No : 733 Date 2011-11-15

  • Courtesy of Hwan Seok Yong MD, Eun-Young Kang MD. / Korea University Guro Hospital
  • Age/Sex 50 / F
  • Chief ComplaintCough
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Airway Involvement in Sarcoidosis
Radiologic Findings
Chest CT scan show predominant peribronchovascular and subpleural nodules in both lungs. Nodularity are also seen on lower trachea and both main bronchi. Elarged lymph nodes are seen in mediastinuma and hilar areas.
Brief Review
Sarcoidosis is a multisystemic granulomatous disease of unknown cause that is characterized by the formation of noncaseous epithelioid cell granulomas. Sarcoidosis primarily affects the lung and lymphatic systems.Sarcoidosis involves the respiratory system in > 90% of cases, usually the hilar and mediastinal nodes, and, less frequently, the lung tissue. Airway involvement, as judged by clinical features, physiologic testing, imaging techniques, bronchoscopy, and airway mucosal biopsy, has been observed in nearly two-thirds of patients with sarcoidosis.The initial morphologic abnormality is the airway inflammation manifested by mucosal edema, erythema, and the formation of granulomas. As the airway disease progresses, the mucosa may demonstrate granularity, nodularity, cobblestoning, and friability. Sarcoid nodules in the bronchi may cause postobstructive atelectasis, airway luminal narrowing, and distortion. As the fibrotic phase sets in, mucosal thinning, pallor, and scarring may lead to airway luminal narrowing and stenosis. CT scans may demonstrate bronchial distortion, angulation, and displacement. Decreased airway luminal diameter caused by endobronchial granulomas and evidence of bronchial mural thickening may be seen. Extrinsic compression of the airways by the enlarged lymph nodes may be depicted. However, CT scans can be misleading and provide false-positive results, incorrectly predicting the presence of focal bronchial abnormalities in up to 15% of patients.The main role of chest CT scanning is to evaluate the thoracic lymph nodes and pulmonary parenchymal process. Its role in assessing airways is limited and is rarely indicated for serial follow-up of the airway disease.
References
1. Akira M, Kozuka T, Inoue Y, et al.Long-term follow-up CT scan evaluation in patients with pulmonary sarcoidosis. Chest 2005; 127:185
2. Polychronopoulos VS, Prakash UB. Airway involvement in sarcoidosis. Chest 2009; 136:1371-1380
3. Hennebicque AS, Nunes H, Brillet PY, et al.CT findings in severe thoracic sarcoidosis. Eur Radiol 2005; 15:23
Keywords
lung, airway, metabolic ans storage,

No. of Applicants : 101

▶ Correct Answer : 79/101,  78.2%
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Hopital Louis Pradel LYON , France matthieu ROUSSET
  • - Iwate Med.Univ , Japan kikuchi koyo
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - HSC , Brazil Diogo Pinheiro
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - stanley medical college &ghtm , India sivaraja
  • - KING ABDULAZIZ SPECIALIST HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - University of British Columbia , Canada Amr Ajlan
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Seoul National University Hospital , Korea (South) Hyungjin Kim
  • - Okayama University , Japan Akihiro Tada
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - chp st martin , France Mariotte benoit
  • - radiologist, aditya imaging centre , India vivek patel
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - UWO , Canada S Lee
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - KOREA UNIVERSITY ANSAN HOSPITAL , Korea (South) Inyoung Choi
  • - FORTIS HOSPITAL KOLKATA , India SALIM PARVEZ
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - Mallinckrodt Institute of Radiology , United States Joseph Azok
  • - SMC , Korea (South) JIHYE MIN
  • - kurdistan , Iran sirwan akhgar
  • - All India Institute of medical sciences , India Justin Moses
  • - NMC, sunder lal jain hospital , India sanjeev vachher
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Korea university , Korea (South) Kun Woo Kang
  • - McGill University , Canada St�phane Beaudoin
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - DRRPGMC KANGRA AT TANDA , India Dinesh Sood
  • - National Jewish Health , United States Jonathan Chung
  • - Kobe City Medical Center General Hospital , Japan Junko Ochi
  • - Korea university , Korea (South) SUMIN HA
  • - Kyungpook National University Medical center , Korea (South) Sunkyung Lim
  • - , Korea (South) Seung Soo Kim
  • - Hopital Louis pradeil , France Philippe Douek
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Semmelweis University , Hungary gabriella gyori
  • - CHRU lille , France manuel toledano
  • - IRSA , France jean-luc BIGOT
  • - Mackay Memorial Hospital, Taipei , Taiwan Sheng-Yeh Shen
  • - Hanyang Medical Center , Korea (South) Ki Yoon
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - snuh , Korea (South) Choo jiyung
  • - Paramount Diagnostic & Research Centre , India Mahavir Swami
  • - MAMC and LNH , India ravi shekhar
  • - o2 clinic, pudukottai, india , India siva raja
  • - Gangnam severance hospital , Korea (South) Sejin Nam
  • - Montreal , Canada D J
  • - Gwangju 21st century hospital , Korea (South) Hyungwoo Oh
  • - Chonnam national univ. hospital , Korea (South) Choi Seul Gi
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - NASA SCANS , India RAKESH BHATIA
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
  • - Private sector , Greece Vasilios Tzilas
  • - ministry of health , United Arab Emirates jesia mansoor
  • - A.P.Chest hospital ,hyderabad , India bhaskar kakarla
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
▶ Correct Answer as Differential Diagnosis : 13/101,  12.9%
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - stanley medical college , India arivudai nambi
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Dong-A University Hospital , Korea (South) Bo Sung Kim
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Chonnam National University , Korea (South) se hee Jung
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Jaseng Oriental Hospital , Korea (South) Byung-June Jo
  • - Severance hospital , Korea (South) Saerom Hong
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