La sarcoidosis torácica / Update thoracic sarcoidosis

La sarcoidosis es una enfermedad granulomatosa multisistémica de causa desconocida, que afecta principalmente a los ganglios linfáticos torácicos y a los pulmones. La estadificación, que agrupa a los pacientes con similar probabilidad de remisión espontánea, se basa en los hallazgos de la radiografía de tórax, que tiene menor sensibilidad que la tomografía computarizada de alta resolución (TCAR) para detectar la afectación ganglionar, pulmonar y bronquial. Los hallazgos en TCAR pueden ser típicos, prácticamente patognomónicos, o atípicos. La TCAR aporta información sobre la actividad de la enfermedad y detecta incipientes signos de fibrosis y otras complicaciones. Para realizar el diagnóstico es precisa la correlación clínica, radiológica, y en muchos casos anatomopatológica. La afectación cardiaca puede provocar muerte súbita; el diagnóstico, difícil, se basa en varias pruebas de imagen, como la resonancia magnética, que tiene mayor especificidad, y la tomografía por emisión de positrones; la confirmación mediante biopsia endomiocárdica se obtiene en pocos pacientes (AU)

Cardiac involvement can cause sudden death. The diagnosis of cardiac involvement is difficult; it is based on various imaging tests, like magnetic resonance imaging, which is more specific, and positron emission tomography. Diagnostic confirmation by endomyocardial biopsy is obtained in few patients. Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. It mainly affects the thoracic lymph nodes and the lungs. The staging of sarcoidosis, which classifies patients according to their probability of spontaneous remission, is based on the plain chest film findings. Plain chest films are not as sensitive as high resolution computed tomography (HRCT) at detecting involvement of the lymph nodes, lungs, or bronchi. The high resolution CT findings can be typical, practically pathognomic, or atypical. High resolution CT provides information about the activity of the disease and detects incipient signs of fibrosis and other complications. To reach the diagnosis, it is necessary to correlate the clinical and radiological findings (and often the histological findings) (AU)

[Thoracic sarcoidosis]. / La sarcoidosis torácica.

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. It mainly affects the thoracic lymph nodes and the lungs. The staging of sarcoidosis, which classifies patients according to their probability of spontaneous remission, is based on the plain chest film findings. Plain chest films are not as sensitive as high resolution computed tomography (HRCT) at detecting involvement of the lymph nodes, lungs, or bronchi. The high resolution CT findings can be typical, practically pathognomic, or atypical. High resolution CT provides information about the activity of the disease and detects incipient signs of fibrosis and other complications. To reach the diagnosis, it is necessary to correlate the clinical and radiological findings (and often the histological findings). Cardiac involvement can cause sudden death. The diagnosis of cardiac involvement is difficult; it is based on various imaging tests, like magnetic resonance imaging, which is more specific, and positron emission tomography. Diagnostic confirmation by endomyocardial biopsy is obtained in few patients.

Tuberculosis pulmonar con signo de cúmulo sarcoideo en la tomografía computarizada de tórax de alta resolución. Respuesta de los autores / No disponible

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El "cúmulo sarcoideo". Un nuevo signo en tomografía computarizada de tórax de alta resolución / The "sarcoid cluster sign". A new sign in high resolution chest CT

Objetivos: Valorar la presencia de múltiples nodulillos puntiformes formando un grupo en el pulmón periférico en pacientes con sarcoidosis y describir este hallazgo como el nuevo "signo del cúmulo sarcoideo" en tomografía computarizada de alta resolución (TCAR).Material y métodos: Estudio retrospectivo de las TCAR de 91 pacientes diagnosticados de sarcoidosis torácica en el Hospital de León. Se valoró la presencia de grupos de múltiples nodulillos puntiformes en el pulmón periférico ("signo del cúmulo sarcoideo"), su morfología redonda o alargada y su distribución en los campos pulmonares. Se utilizaron reconstrucciones de máxima intensidad de proyección. Se realizó correlación radiopatológica en 3 pacientes. Material y métodos: Posteriormente, se valoró la presencia de este signo en TCAR en 120 pacientes consecutivos estudiados por sospecha de enfermedad pulmonar infiltrativa difusa (EPID). Resultados: De los 91 pacientes con sarcoidosis, 9 (6 varones y 3 mujeres, con edad media de 29 años) presentaban el "signo del cúmulo sarcoideo" en TCAR. La mayoría de los cúmulos mostraban morfología redondeada y su distribución fue predominante en la zona periférica no subpleural de los campos pulmonares superiores y medios; cuando los cúmulos tenían distribución periférica subpleural, nodulillos subpleurales formaban parte del cúmulo. Los cúmulos correspondían a granulomas no caseosos, no coalescentes, con predominio de linfocitos CD4+, sin fibrosis y con distribución linfangítica. Resultados: Únicamente 2 de los 120 pacientes con sospecha de EPID mostraban grupos periféricos de múltiples nodulillos puntiformes ("signo del cúmulo sarcoideo"); los 2 correspondían a sarcoidosis. El total de sarcoidosis diagnosticadas en este grupo fue de 1. Conclusión: El nuevo “signo del cúmulo sarcoideo” en TCAR solamente se ha observado en pacientes jóvenes con sarcoidosis pulmonar. Puede ser un hallazgo radiológico útil en el diagnóstico de esta enfermedad (AU)

Objectives: To evaluate the presence of clusters of multiple small punctiform nodules in the peripheral regions of the lung in patients with sarcoidosis, and to report this finding as a new sign "the sarcoid cluster sign" in high-resolution chest CT (HRCT). Material and methods: This is a retrospective study of the HRCT findings in 91 patients diagnosed with lung sarcoidosis at our hospital. We evaluated the presence of clusters of multiple small punctiform nodules in the periphery of the lungs (the "sarcoid cluster sign"), whether these were rounded or long in shape, and their distribution in the lung fields. We used reconstructions of maximum intensity projections (MIP). We correlated the imaging and histopathological results in three patients. Material and methods: Afterward, we evaluated the presence of the “sarcoid cluster sign” on high resolution CT findings in 120 consecutive patients studied for suspected diffuse lung disease. Results The "sarcoid cluster sign" was present at HRCT in 9 of the 91 patients with sarcoidosis (6 men and 3 women; mean age 29 years). Most clusters were rounded and most were located in the non-subpleural peripheral regions of the upper and middle fields of the lungs. When the clusters were located in the subpleural peripheral regions, the clusters contained small subpleural nodules. The correlation between the imaging and histopathological results revealed that the clusters corresponded to non caseous, noncoalescing granulomas with a predominance of CD4+ lymphocytes, without fibrosis, that were distributed in the lymph vessels. Results Only 2 of the 120 patients with suspected diffuse lung disease had peripheral clusters of multiple small punctiform nodules (the "sarcoid cluster sign"); these two patients had sarcoidosis, and a total of 21 cases of sarcoidosis were diagnosed in this group. Conclusion: The "sarcoid cluster sign" on HRCT has been observed only in young patients with lung sarcoidosis. This finding could be useful in the diagnosis in the diagnosis of this disease (AU)

[The "sarcoid cluster sign". A new sign in high resolution chest CT]. / El "cúmulo sarcoideo". Un nuevo signo en tomografía computarizada de tórax de alta resolución.

OBJECTIVES: To evaluate the presence of clusters of multiple small punctiform nodules in the peripheral regions of the lung in patients with sarcoidosis, and to report this finding as a new sign "the sarcoid cluster sign" in high-resolution chest CT (HRCT). MATERIAL AND METHODS: This is a retrospective study of the HRCT findings in 91 patients diagnosed with lung sarcoidosis at our hospital. We evaluated the presence of clusters of multiple small punctiform nodules in the periphery of the lungs (the "sarcoid cluster sign"), whether these were rounded or long in shape, and their distribution in the lung fields. We used reconstructions of maximum intensity projections (MIP). We correlated the imaging and histopathological results in three patients. Afterward, we evaluated the presence of the "sarcoid cluster sign" on high resolution CT findings in 120 consecutive patients studied for suspected diffuse lung disease. RESULTS: The "sarcoid cluster sign" was present at HRCT in 9 of the 91 patients with sarcoidosis (6 men and 3 women; mean age 29 years). Most clusters were rounded and most were located in the non-subpleural peripheral regions of the upper and middle fields of the lungs. When the clusters were located in the subpleural peripheral regions, the clusters contained small subpleural nodules. The correlation between the imaging and histopathological results revealed that the clusters corresponded to noncaseous, noncoalescing granulomas with a predominance of CD4+ lymphocytes, without fibrosis, that were distributed in the lymph vessels. Only 2 of the 120 patients with suspected diffuse lung disease had peripheral clusters of multiple small punctiform nodules (the "sarcoid cluster sign"); these two patients had sarcoidosis, and a total of 21 cases of sarcoidosis were diagnosed in this group. CONCLUSION: The "sarcoid cluster sign" on HRCT has been observed only in young patients with lung sarcoidosis. This finding could be useful in the diagnosis in the diagnosis of this disease.