Radiological diagnosis of fibrosing sarcoidosis of the respiratory organs

Amosov I.V., Speranskaia A.A.,  Baranova O.P.,   Yakovleva N.S., Zolotnitskaia V.P.

The widespread use of computed tomography (CT) with High Resolution (HR) revealed atypical clinical and radiation forms of pulmonary sarcoidosis (PS) with excessive fibrosis of the lung tissue, which needs treatment correction and administration of antifibrotic therapy.

Purpose. To evaluate radiation patterns of pulmonary fibrosis in sarcoidosis.

Material and methods. From 2006 to 2019. in Pavlov First Saint Petersburg State Medical University there have been 712 patients with sarcoidosis, of which with PS (stage 4th) - 68 patients (9.5%), of whom 31 patients (4.3%) had a severe course of the disease with dyspnea (up to dyspnea at rest) and radiation signs of fibrosis, not characteristic of the classic course and not corresponding to traditional radiology and the existing X-ray classification of pulmonary sarcoidosis (PS). The average age of patients was 42.2 ± 6.4 years (w / m - 17/14). All patients underwent routine X-ray examination (X-ray in two projections), HRCT, pulmonary function tests (PFTs) and echocardiography.

Results. Analysis of the results of radiation studies revealed typical radiation manifestations of PS (Stage 4) in 37 patients (5.2%). Atypical manifestations of fibrosis in PS were detected in 31 patients (4.3%): idiopathic pulmonary fibrosis in 11 patients (1.5%), peribrochovascular fibrosis with the formation of honeycomb in parahilars in 7 patients (1%), fibrosis in the upper-back parahilars with a small diameter honeycombs in the upper subpleural regions in 6 patients (0.9%), the fibro-cavitary form of PS was detected in 7 patients (1%).

Conclusions. The accumulation of experience in the clinical-radiological examination of patients with PS revealed fibrosing forms of PS, which are difficult to diagnose and require the development of new approaches in diagnostic and treatment tactics.

Department of Radiology and Radiation Medicine, Department of Pulmonology, I.P. Pavlov First St.-Petersburg State Medical University. Saint-Petersburg, Russia.

 

Keywords: computed tomography, pulmonary sarcoidosis.

 

Corresponding author:  Speranskaia A. A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript .

 

For citation: Amosov I.V., Speranskaia A.A.,  Baranova O.P.,   Yakovleva N.S., Zolotnitskaia V.P. Radiological diagnosis of fibrosing sarcoidosis of the respiratory organs. REJR 2019; 9(4):56-67. DOI:10.21569/2222-7415-2019-9-4-56-67.

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Received:        17.09.19 Accepted:       14.10.19