thoracic sarcoidosis

Last reviewed 01/2018

Thoracic involvement is seen in >90% of patients with sarcoidosis (1)

  • parenchymal and airway involvement (larynx, trachea and bronchi)
    • lung involvement may vary from alveolitis and granulomatous infiltration (in early stages of sarcoidosis) to fibrosis with bronchiolectasis (in a later stage of the disease) (2,3)

  • intrathoracic lymphadenopathy
    • bilateral hilar lymphadenopathy is the commonest thoracic manifestation
    • unilateral hilar lymphadenopathy is present in 3% to 5% of patients
    • mediastinal lymphadenopathy in the absence of hilar lymph node enlargement indicates an alternative diagnosis (1)

  • rarely the pleura maybe affected as well - pleural thickening, pleural effusion and chylothorax (3)

Patients may present with dyspnoea, dry cough and chest pain. Most patients with massive hilar and/or mediastinal lymphadenopathy are asymptomatic but some may have fatigue, retrosternal pain and/ or dysphagia (3).

Physical finding are usually minimal or absent:

  • crackles are seen in less than 20% of patients - usually these are fine interstitial crackles in the upper lobes
  • clubbing is rarely seen - if present suspect an alternative diagnosis (4,5)

Secondary complications may be seen in patients who develop pulmonary fibrosis e.g. - infection (aspergilloma, mycobacterial), pneumothorax, respiratory failure, and pulmonary hypertension (5)

Prognosis is generally good, but a few patients die due to progressive disease (6)

Reference:

Related pages:

pulmonary hypertension in sarcoidosis