Medical Central Resource

Pulmonary Sarcoid-Stage II

45 year old male with abnormal pulmonary function tests.

Plain X-ray

Bilateral hilar fullness with patchy mixed air-space/interstitial disease and thickened septal lines peripherally.

SARCOIDOSIS=non-caseating granulomas

? etiology
Age peak: 20-40 years
Black/White 14:1 - M/F 1/3
May manifest
- Acutely:
  1. Bilat adenopathy, +/- fever
  2. Erythema nodosum, arthralgis
- Chronically:
  1. Asymptomatic (50%)
  2. Symptomatic: fever, malaise, weigth loss, SOB 25%
Diagnosis: Typical history/organ involvement, +Kveim-Siltzbach skin test (70%), Elevated ACE levels (70)%. Also look for hypercalcemia and hypercalciuria.
Abnl CXR ~90%
Radiographic Staging:
- Stage 0 - No demonstratable abnormality
- Stage 1 - Hilar Adenopathy Only -- Rarely symptomatic
- Stage 2 - Hilar Adenopathy + lung lesions -- PFT's typically restrictive
- Stage 3 - Pulmonary lesions, no adenopathy; without pulmonary fibrosis
- Stage 4 - Pulmonary lesions, no adenopathy; with pulmonary fibrosis (worst prognosis)

Submitted by: Michael W. Freckleton,Maj,USAF,MC,Wilford Hall Medical Center
Reviewed by: Christopher Nusser,Capt,USAF,MC,Wilford Hall Medical Center