IMAGING OF PULMONARY SARCOIDOSIS AND ITS CORRELATION WITH SMOKING - OUR EXPERIENCE
DOI:
https://doi.org/10.55302/wkewyj97Keywords:
high-resolution computer tomography, interstitial disease, nonsmokers, sarcoidosis, smokingAbstract
Introduction: Sarcoidosis is a multisystemic granulomatous disease that usually affects lung parenchyma with interstitial and granulomatous changes of varying intensity and expression, depending on the degree of the disease.
The aim of the study: To detect pulmonary changes of sarcoidosis on high-resolution CT (HRCT) and to correlate them with smoking.
Material and Methods: Computed tomography with high resolution was made on 128 slice CT scanner PHILIPS INCISIVE, using 1mm thin-slice thickness and high spatial frequencies algorithm for image reconstruction. A total of 50 patients diagnosed with sarcoidosis who came to our University Clinic of Pulmonology and Allergology - Skopje were included in this study and their HRCT findings were compared to smokers and non-smokers.
Results: The gender structure of the patients is predominantly made up of female patients 92% vs 8% male. Reticular opacities on HRCT were more often seen in smokers compared to non-smokers, with a statistically significant difference confirmed for their peripheral and subpleural localization (p=0.0034 and p=0.0014, respectively in the upper and middle lung zones, and in the lower lung zones). Smoking patients had insignificantly more often peribronchovascular localization of reticular opacities in the upper and middle lung zones (26.67% vs 10%, p=0.28) and in the lower lung zones (26.67% vs 20%, p=0.74). Regarding the smoking status, 16% of the patients declared themselves as current smokers, 56% as ex-smokers, with an average smoking experience of 14.9 ± 4.8 years.
Conclusion: HRCT is the method of choice in the evaluation of pathological changes in pulmonary sarcoidosis. It shows very precisely the characteristic findings of lymph nodes, micronodules and other lesions, their distribution, as well as atypical changes. Smoking plays a certain role in the interstitial changes of the patients with sarcoidosis, although we do not have data whether smoking has effects on the extent, course or outcome of the disease.
Downloads
References
1. Statement of sarcoidosis: Joint statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS board of directors and by the ERS executive committee, February 1999. Am J Crit Care Med 1999;160:736-755.
2. Dhagat PK, Singh S, Jain M, Singh SN, Sharma RK. Thoracic Sarcoidosis: Imaging with High Resolution Computed Tomography. J Clin of Diagn Res. 2017;11(2):TC15-TC18. https://www.doi.org/10.7860/JCDR/2017/24165/9459.
3. KIM JE, Callard RH, King ET JR. Rheumatoid Artritis-Associated Interstitial Lung Disease. CHEST 2009;136:1397–1405. DOI: 10.1378/chest.09-0444.
4. Muller-Quernheim J, Prasse A, Zissel G. Sarcoidosis. Presse Med. 2012 Jun;41(6 Pt 2):e275-87. doi: 10.1016/j.lpm.2012.03.018. Epub 2012 May 15.
5. Criado E, Shanchez M, Ramirez J, Arguis P et al. Pulmonary Sarcoidosis: Manifestation of High Resolution CT with Pathologic Correlation. Chest Imaging. 2010;1567-1569.
6. Lynch DA, Sverzellati N, Travis WD, et al. Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. Lancet Respir Med 2018;6(2):138-153.
7. Scadding JG. Prognosis of intrathoracic sarcoidosis in England. A review of 136 cases after five years observation. Br Med J. 1961;2:1165-72.
8. Patil SN, Levin DL. Distribution of thoracic lymphadenopathy in sarcoidosis using computed tomography. J Thorac Imaging 1999;14:114-117.
9. Ors F, Gumus S, Aydogan M, et al. HRCT findings of pulmonary sarcoidosis; relation to pulmonary function tests. Multidiscip Respir Med 2013;8:1-8.
10. Craido E, Sanches M, Ramirez J et al. Pulmonary Sarcoidosis; typical and atypical manifestations at high-resolution CT with pathologic correlation. RadioGraphics 2010;30(6):1567-1586.
11. Nishino M, Lee KS, Itoh H, et al. The spectrum of pulmonary sarcoidosis: Variations of high-resolution CT findings and clues for specific diagnosis. Eur J Radiol 2010;73:66-73.
12. Wilson AG, Hansel DM. Immunologic diseases of the lung. In: Armstrong P, Wilson AG, Dee P, Hansell DM, editors. Imaging of the diseases of the chest. 3rd ed. NW, London: Mosby; 2000. p. 637-88.
13. Webb WR, Muller NL, Naidich DP. High-resolution CT of the lung, 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2000.
14. Itoh H, Nishino M, Hatabu H. Architecture of the lung: morphology and function. J Thorac Imaging 2004;19:221-7.
15. Rosen Y. Pathology of sarcoidosis. Semin Respir Crit Care Med 2007;28:36-52.
16. Wuyts WA et al. Differential diagnosis of ususal interstitial pneumonia: when is it truly idiopathic? European Respiratory Review 2014;23:308-319.
17. Martin SG, Kronek LP, Valeyre D, Brauner N, Brillet PY, Nunes H, et al. High-resolution computed tomography to differentiate chronic diffuse interstitial lung diseases with predominant ground-glass pattern using logical analysis of data. Eur Radiol. 2010;20:1297-1310.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright of their work and grant the Macedonian Journal of Anaesthesia the right of first publication.
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Authors are permitted to enter into separate, additional contractual arrangements for the non-exclusive distribution of the published version of the work, provided that its initial publication in this journal is acknowledged.
