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Has mediastinoscopy still a role in suspected stage I sarcoidosis?
Pakhale, Smita Sakha; Unruh, Helmut; Tan, Lawrence; Sharma, Sat.
Afiliação
  • Pakhale SS; Sections of Pulmonary and Critical Care, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
Sarcoidosis Vasc Diffuse Lung Dis ; 23(1): 66-9, 2006 Mar.
Article em En | MEDLINE | ID: mdl-16933472
INTRODUCTION: Whether diagnostic mediastinoscopy is needed for confirmation of diagnosis in patients who present with clinical stage I sarcoidosis and no lung lesions on CT scan, is not known. METHODS: A retrospectively review of all mediastinoscopies performed from 1992 to 2003 at Health Sciences center, Winnipeg, Canada yielded 55 patients with hilar and mediastinal lymphadenopathy and normal lung parenchyma on thoracic computerized axial Scan. RESULTS: Out of a total of 1462 procedures, 55 patients with a presumptive diagnosis of Stage I sarcoidosis underwent mediastinoscopy. Median age at presentation was 47.4 +/- 12.8 years (range 24-77). The patients had mild symptoms of cough (30.9%), dyspnea (20.0%), chest pain (14.6%), malaise in (20.0%), erythema nodosum (3.6%) and uveitis (3.6%). Thoracic CT scan revealed bilateral hilar lymphadenopathy in 9 (16%), bilateral hilar lymphadenopathy plus right paratracheal lymphadenopathy in 35 (63%), right paratracheal lymphadenopathy in 7 (12%) and unilateral hilar lymphadenopathy in 4 (7.1%) subjects. Pathology revealed noncaseating granuloma, suggestive of sarcoidosis in 49 (89.1%), reactive lymph nodes in 5 (9.1%) and was nondiagnostic in 1 (1.8%). Only 2 out of these 6 non-sarcoid patients had bilateral hilar lymphadenopathy. Biopsy cultures were negative for fungus and mycobacterium in all patients. CONCLUSION: Clinical presentation of minimal symptoms, mediastinal lymphadenopathy (especially bilateral hilar and right paratracheal lymphadenopathy) with normal parenchyma on CT scan strongly suggests a diagnosis of sarcoidosis. In these cases, confirmation of the diagnosis by mediastinoscopy and lymph node biopsy is unwarranted.
Assuntos
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Base de dados: MEDLINE Assunto principal: Sarcoidose / Doenças Linfáticas / Mediastinoscopia Tipo de estudo: Observational_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2006 Tipo de documento: Article
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Base de dados: MEDLINE Assunto principal: Sarcoidose / Doenças Linfáticas / Mediastinoscopia Tipo de estudo: Observational_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2006 Tipo de documento: Article