Sarcoidosis (X-ray picture of the pulmonary stage of sarcoidosis). Sarcoidosis of the lungs and intrathoracic lymph nodes X-ray variants of sarcoidosis

Chest x-rays show characteristic changes in almost 90% of cases, even in asymptomatic cases. Therefore, X-ray of the lungs for sarcoidosis remains the main method of primary radiation examination and is widely used for diagnosis and staging of the disease.

Radiography is a fairly accessible and safe method. Its disadvantage is its low resolution and contrast, as well as the effect of image layering (summation). In addition to X-rays of the lungs, ultrasound examinations, positron emission tomography, high-resolution X-ray computed tomography, isotope scanning and magnetic resonance imaging are used.

Identification of stages of pulmonary sarcoidosis from photos

The picture observed with pulmonary sarcoidosis in the photo varies significantly depending on (5 stages or variants of symptom complexes).

• Stage 0: normal radiograph (seen in 5-10% of patients).
• Stage 1: enlarged lymph nodes in the chest (45-65% of patients). Due to this, the shadows of the mediastinum and the roots of the lungs in the photo are expanded and lengthened. As a result of enlarged lymph nodes, the bronchi are compressed. Lymph nodes do not merge, as in tuberculosis, but remain separated from each other. Enlarged lymph nodes are often observed on only one side (usually the right).
• Stage 2: enlarged lymph nodes, damage to the lungs themselves (25-30% of patients). The x-ray shows multiple scattered nodules (up to 5-7 mm) in the lung tissues. Moreover, unlike the picture for tuberculosis, the upper lung fields are not affected by the lesion. The pattern of the lungs is excessive and sometimes deformed. A “frosted glass” effect is noticeable when the transparency of the lung tissue decreases.
• Stage 3: lung damage (15% of patients). The radiograph is characterized by an increase in nodules, their merging, and the formation of clusters.
• Stage 4: pulmonary fibrosis (5-15% of patients).

Photo of an X-ray of the lungs in stage 2 sarcoidosis

Photo of an X-ray of the lungs in the 3rd stage of sarcoidosis

Photo of an X-ray of the lungs in stage 4 sarcoidosis

Adequacy of the reflection of the stage of sarcoidosis from the photo

With sarcoidosis, the photo usually adequately reflects the patient’s condition, although often the manifestations of the disease are more pronounced than the patient’s functional impairment. It was even suggested that the dynamics of the disease over time do not correspond to traditional radiographic stages. Therefore, they often speak not about the stages of the disease according to complexes of radiological signs, but about its radiation types.

Various lesions of the intrathoracic lymph nodes.

Bronchoscopy reveals indirect signs of hyperplasia of the lymph nodes in the form of widening of the angles of bronchial divisions, the appearance of a vascular network of the bronchial mucosa. In 10 - 15% of cases there is a tubercular lesion of the mucous membrane. Biopsy of the mucous membrane and transbronchial puncture of the lymph nodes make it possible to verify the diagnosis in 70 - 80%, and in combination with mediastinoscopy or open biopsy - in 100% of cases. The described stage of sarcoidosis has a very characteristic radiological picture, which, in combination with scant clinical manifestations or in combination with Löfgren's syndrome, makes it possible to establish the diagnosis of sarcoidosis without a biopsy.

Positive radiological dynamics with a favorable course of the disease in 80 - 88% of cases is manifested by complete regression of adenopathy and normalization of the pulmonary pattern within 4 - 8 months. (Rabukhin E. A., 1975; Yaroszewicz W., 1976), spontaneous recovery is achieved within 6 months. up to 3 years. At the same time, relapses are observed 3 times more often than in treated patients (Kostina Z. I., 1984).

At the III, or pulmonary, stage of sarcoidosis, the disease is considered as a chronic process, resulting from the progression of the previous mediastinal-pulmonary stage.

In approximately 25% of cases the disease is asymptomatic. In the same number of patients, a secondary infection quite quickly joins the main process, and then chronic bronchitis and cor pulmonale develop. In stage III, all patients have respiratory failure to one degree or another: shortness of breath during exercise, and then at rest, cough, sometimes low-grade body temperature, especially in the case of a nonspecific bronchial tract infection.

"Differential X-ray diagnostics
diseases of the respiratory system and mediastinum",
L.S.Rozenshtrauch, M.G.Winner

2007-09-24 Anonymous

I read the discussion and got the impression that 3rd year students were discussing it.

Firstly, it is generally impossible to judge the nature of the process from the presented photographs, and here’s why. Firstly, their size does not stand up to criticism: it would be better to have only 1 photo, but with good resolution. Second, where is the soft tissue window to evaluate the mediastinum and pulmonary roots? It is possible to judge the absence of lymphadenopathy only approximately, and it is impossible to evaluate the lung tissue in principle, because to visualize the lung tissue of all disseminated processes, high-resolution thin-slice CT (HRCT) is used, with the thickness of the reconstruction layer (in the case of a spiral tomograph) or the thickness of the collimation beam (in the case of step-by-step tomograph) 1 mm, maximum 2 mm. With a thicker layer (and in the presented tomograms it is certainly no less than 5 mm), it is impossible to assess the nature of the location of the foci - to distinguish their perilymphatic location from centrilobular or mixed, and in the case of sarcoidosis this is of fundamental importance. In sarcoidosis, the lesions are located perilymphatically - in the pulmonary interstitium along the route of the lymphatic vessels, i.e. in the walls of the bronchi and along the vascular bundles and pleural layers, as well as in the interlobular septa. This forms the characteristic picture of the rosary. I repeat, it is impossible to reliably assess this on thick sections.

In this case, in the absence of a correctly performed CT scan, one can judge only by indirect signs, which, alas, are clearly visible on radiographs.

What kind of sarcoidosis is it: the location of the lesions is predominantly in the central parts of the lungs, involvement of the pleura.
What's against: the absence of lymphadenopathy (as far as one can judge from the pulmonary window), the absence of a predominance of focal changes in the upper and middle parts of the lung tissue, the absence of infiltrates (which is typical for an advanced untreated process). All this, of course, does not exclude sarcoidosis, but prompts us first of all to exclude other disseminated diseases, the most dangerous of which, naturally, are miliary tuberculosis and hematogenous carcinomatosis.
Histiocytosis X is excluded because it is characterized by multiple small cysts.

2007-10-01 Anonymous

Of course, you are an ass... But sarcoidosis can occur with a predominance of either pulmonary changes or lymphadenopathy (LAP) of the OGK. The absence of PAP OGK is not a fact contradicting the presence of sarcoidosis. The sections are important, but I note that it is the characteristic changes in the middle, and not the upper section, that are specific for sarcoidosis.
Regarding the thickness of the cut, I also do not completely agree with your opinion. It is also possible to distinguish the nature of the distribution of lesions from 5 mm sections. Which is what the researcher did. The picture of the rosary that you give is typical for a few outbreaks. In this case, we have the opposite... This is not the case here... stage 2 is already forming, with peribronchial fibrosis..
Good luck to all!

2007-10-01 Anonymous

Colleague, peribronchial nodules can also occur with pneumonia. In your opinion, if there are both centrilobular and peribronchial nodules, then this is against sarcoidosis??? Identification of the type of lesions is important, but is not the end of the entire diagnostic conclusion. If the difference between disseminations was so simple and clear, then there would be no problems with their diagnosis.

2007-10-05 BGU

Yes, indeed, with sarcoidosis, only pulmonary manifestations are possible. And it doesn’t have to be only at stage 3. The nodules can be either peribronchial or centrilobular, but there are simply more of the former.
Thanks to the author for the clinical case, especially supported by other skin manifestations of sarcoidosis. sarcoidosis is multifaceted...

2009-06-02 Anonymous

Is sarcoidosis inherited???????

2009-06-27 Anonymous

2009-11-12 Anonymous

2009-12-01 Anonymous

Hello! I am a general practitioner. Since 2007, small-focal dissemination was discovered. Have you diagnosed sarcoidosis? I foolishly went to the PTD, they clung to all this. Now on the survey OGK and P-tomogram there are more focal shadows on the right in the 3rd segment and on the left in the 1st and 2nd segment , plus a reticular deformation of the pulmonary pattern in the middle lobe, a volumetric decrease in the upper lobe of the left lung, there is compaction and thickening of the perilobular interstitium. A bunch of radiologists, pulmonologists, phthisiatricians and even professors looked at me and they couldn’t say anything without histology (transthoracic biopsy). I also caused myself a problem with TB doctors due to my stupidity. Tell me what to do in my situation. Thank you!

2010-12-20 Anonymous

The anamnesis material and KLA data are insufficiently presented. There are no direct overview and lateral images of the lungs, CTG projections

2011-02-13 Anonymous

Yes, you can’t talk about sarcoidosis just based on these tomograms. Yes, both the clinical picture and this radiation image can be with a mass of diffuse changes in the lungs, starting with infectious diseases. If there are no radiographs with polycyclic emphasized contours of enlarged dense bronchopulmonary lymph nodes and histological confirmation, declaring sarcoidosis is declaring...

2011-06-08 Anonymous

2011-11-21 Anonymous

For a year now I have been given two diagnoses under? sarcoidosis? lymphogranuloma? It is impossible to take a transthoracic biopsy; they propose to perform a diagnostic operation by opening the chest. Tell me, dear doctors, is it possible to determine without this operation? In sarcoidosis, can there be formations or lymph nodes in the posterior mediastinum?

2012-01-21 Anonymous

DO YOU NOT WANT TO DECIDE AND ARE NOT CONFUSED BY THE LOST TIME? IS THE DIAGNOSIS PROCEDURE ITSELF THE MOST UNPLEASANT THING? DON'T YOU NEED TREATMENT?

Author qualifications:PATIENT WITH SARCOIDOSIS Author qualifications:The author refused to indicate his qualifications, experience and length of service. He probably doesn't want to be held accountable for his opinion. The competence of the opinion is in question.

2014-03-05 Anonymous

I have had erythema nodalis on my legs for more than 3 years. I have been suffering for 3 years, shortness of breath, fever, weakness. Treatment is prednisolone, warfarin, Corvazan, Plaquenil. There is no point. spots appear, open, rot for half a year, from prednisolone, the pancreas bothers me.. I understand I need to do something, I don’t know what. Diagnosis of SLE, tests didn’t find scleroderma, sarcoidosis, cough, shortness of breath constantly. Heart, kidney failure 2. Atrial fibrillation for more than 10 years, at first it was paroxysmal, now constant, also the liver is enlarged by 1 cm . GOOD PEOPLE, WHAT SHOULD I DO, I WANT TO LIVE, I haven’t lived for 3 years, but I’m suffering. HELP. [email protected]

Pulmonary sarcoidosis or Schaumann-Besnier-Beck disease is an inflammatory process in the lungs and intrathoracic lymph nodes due to the formation of granulomas (nodules).

It is a non-contagious but very dangerous disease. In the early stages, sarcoidosis may be asymptomatic.

The importance of timely diagnosis of pulmonary sarcoidosis

A rare disease that is still not fully understood. There are no exact theories explaining the causes and nature of its occurrence.

And also there are no specific, initial symptoms characteristic only of this disease. This makes it difficult timely detection diseases.

Similarity of symptoms of pulmonary sarcoidosis with other diseases, for example, tuberculosis, at a later date, does not provide the possibility of proper treatment. The earlier the diagnosis is made, the greater the chances of successful treatment of pulmonary sarcoidosis.

Reference! Sarcoidosis occurs in three phases: initial, mediastial-pulmonary, pulmonary.

Diagnostic methods

There are the following methods for diagnosing pulmonary sarcoidosis.

Computed tomography: is CT x-ray more effective?

This method is the most informative for studying internal organs. The sensitivity of CT is 94%. Significantly higher than other methods, even radiography. There is sensitivity in it - 80%.

Since CT can produce the best quality image, magnify it, it can show lymphadenopathy of the roots of the lungs, which is a sign of pulmonary sarcoidosis.

Photo 1. CT is performed on a special device - a computed tomograph, here is a model from the manufacturer "MAGNETOM Verio".

Diagnosis of sarcoidosis using this method shows the detailed structure of the lungs, which cannot be done with radiography and fluorography.

There are two options for CT scanning: native and contrast. IN first In this case, no preparation is required. And in second- carried out on an empty stomach. For the examination to be effective, the patient must remove all metal objects and lie still.

The CT scan procedure is painless and takes no more than 5 minutes.

Possible signs of pulmonary sarcoidosis on CT:

The most noticeable deformations are visible in the posterior and anterior areas of the upper lobes, in the apical areas of the lower lobes, in the middle lobe, as well as in the lingular segments.

X-ray picture

The use of this method does not provide as much information as CT, but shows changes characteristic of pulmonary sarcoidosis.

Signs of an x-ray picture of the chest organs are divided into the following stages:

1. Zero when there is no change. Occurs in 5% of patients.
2. First: enlarged lymph nodes, no changes in the main lung tissue - parenchyma. Lymph nodes do not connect to each other, as is the case with tuberculosis. They remain isolated.
3. Second: increase in the number of lymph nodes in the roots of the lungs, changes in the parenchyma.
4. Third: the main lung tissue is changed, the number of lymph nodes is increased, their connection to each other.
5. Fourth: pulmonary fibrosis. The underlying lung tissue becomes scarred, impairing breathing.

The listed stages serve as information to predict the course of the patient’s disease.

Important! An x-ray shows changes in the lungs even in the absence of symptoms of the disease. The limitation of the method is inability to provide high resolution images, as well as the ability to layer images.

Laboratory tests of blood, urine

If you suspect the presence of pulmonary sarcoidosis, the doctor will definitely prescribe a general blood test, biochemical analysis of blood and urine.

Before this, the patient must prepare as follows:

• per day avoid drinking alcohol and smoking;
• get tested on an empty stomach in the morning;
• a few days do not use medications that affect the composition of urine and blood.

Based on the results of the general analysis, a conclusion is drawn about the work of the internal organs.

Important! The results of a general blood test are not considered as characteristic features sarcoidosis.

If the disease is present, the following indicators are possible when taking a general blood test:

• reduced level red blood cells;
• increased level leukocytes;
• level increase eosinophils;
• increased content lymphocytes;
• increase in content monocytes;
• moderate increase erythrocyte sedimentation rate.

Due to the fact that the basis of pulmonary sarcoidosis is inflammation, the results of a general analysis for many indicators indicate the presence of an inflammatory process.

Based on a biochemical blood test, it is possible to identify not only inflammation, but also problems with the functioning of internal organs. With pulmonary sarcoidosis, an increase in:

• level of angiotensin-converting enzyme, examined using venous blood;
• calcium levels increases due to the fact that granulomas produce vitamin D, which affects calcium metabolism;
• copper content;
• haptoglobin;
• sialic acid levels, as with any inflammation;
• total protein concentration.

These changes in the blood are characteristic for acute form diseases. In other forms, such changes may not occur. Moreover, increased levels of these components can be found in other diseases. Eg, angiotensin can also be increased when bronchitis, pneumoconiosis, rheumatoid arthritis. Therefore, other methods must be used to determine the diagnosis.

A urine test may reveal elevated calcium levels.

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Bronchoscopy of the lung

Used to assess availability lumens of the bronchi, trachea, mucous membranes. This method of diagnosing pulmonary sarcoidosis is carried out using a long flexible fiber optic probe - a bronchoscope.

Reference! Bronchoscopy is often performed under local anesthesia, less often under general. The bronchoscope is inserted through the nose or mouth into the lungs.

To check for the presence of infectious granulomas, they are used together with bronchoscopy. bronchoalveolar lavage.

A distinctive feature of this method is that it can be used both for diagnostic purposes and as a treatment method.

The diagnostic goal is expressed in taking material for further research.

In the case of sarcoidosis, the following may occur:

• probability of formation tuberculate rashes in the bronchi;
• change vessels of the bronchial mucosa;
• inspection lung tissue on the degree of lymphocytosis.

When performing bronchoscopy, complications such as nosebleeds, irregular pulse, damage to the vocal cords, and puncture of the lung are possible.

Spirography

Using this method, we examine external respiration functions, lung volume during normal and increased breathing.

Preparation for spirography consists of performing it on an empty stomach, in 2 days Before the procedure, stop smoking, drinking alcohol, coffee and black tea, and discontinue certain medications.

Failure to comply with these conditions may result in distorted information.

If the patient has sarcoidosis, then spirography will show visible changes in the functions of external respiration.

Biopsy and histological examination of biopsy samples of lymph nodes and lung tissue

A biopsy is a necessary diagnostic method for pulmonary sarcoidosis, as it allows one to examine them for the presence of pathologies. Carry out this procedure if necessary detailed examination of lung tissue under a microscope.