Objective To investigate the clinical features, chest imaging manifestations, pathological changes, diagnosis and treatment of sarcoidosis with pleural effusion as the initial manifestation, and to analyze the possible causes of misdiagnosis, so as to help clinicians improve their understanding of sarcoidosis with pleural effusion as the initial manifestation, and reduce the rate of clinical misdiagnosis and missed diagnosis. Methods The general data, clinical manifestations, imaging examinations, pathological findings and outcomes of 4 patients with sarcoidosis with pleural effusion as the first manifestation admitted to Ningxia Medical University General Hospital from January 2019 to December 2020 were retrospectively analyzed. Results Out of these patients, 3 were female and 1 was male, with an average age of 50.3 years. The main clinical features were cough, expectoration, chest tightness, shortness of breath and other common respiratory symptoms. Chest CT indicated right pleural effusion. After admission, closed thoracic drainage, tracheoscopy, thoracoscopy, pleural biopsy and cervical lymph node biopsy were performed to obtain pathology. Combined with imaging and pathology, diagnosis was made. After hormone therapy, symptoms and imaging were improved. Conclusions Sarcoidity-related pleural effusion is relatively rare as the first episode, with no specific clinical symptoms and no specific physical and chemical properties of pleural effusion. Non-caseous granulomatous lesions can be found pathologically, and the diagnosis needs to rely on clinical, imaging and pathological comprehensive judgment.
Citation：
WANG Xiuyan, GAO Jianmei, ZHANG Hong, WANG Bei, WANG Shaojin. Sarcoidosis with pleural effusion as the initial manifestation: 4 case reports. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(3): 185-188. doi: 10.7507/1671-6205.202109053
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Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
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- 1. 钟南山, 刘又宁. 呼吸病学. 2 版. 北京: 人民卫生出版社, 2015, 683-693.
- 2. Flammang d'Ortho MP, Cadranel J, Milleron BJ, et al. Pleural, alveolar and blood T-lymphocyte subsets in pleuropulmonary sarcoidosis. Chest, 1990, 98(3): 782-783.
- 3. Soskel NT, Sharma OP. Pleural involvement in sarcoidosis. Curr Opin Pulm Med, 2000, 6(5): 455-468.
- 4. 李南, 王继旺, 朱岩, 等. 结节病伴乳糜胸一例并文献复习. 中国呼吸与危重症监护杂志, 2021, 20(1): 49-53.
- 5. 孙永昌, 姚婉贞, 沈宁, 等. 结节病胸膜病变分析并文献复习. 中华结核和呼吸杂志, 2006, 29(4): 243-246.
- 6. 潘纪戌, 胡荣剑. 高分辨率肺部 CT. 5 版. 北京: 中国科学技术出版社, 2017, 344-372.
- 7. Fontecha Ortega M, Rodríguez Álvarez SJ, García Satué JL. Pleural effusion: a rare manifestation of sarcoidosis. Arch Bronconeumol, 2017, 53(3): 170-171.
- 8. 蔡闯, 何慕芝, 李德荣, 等. 胸膜肺结节病2例病例报告及文献复习. 解放军医学杂志, 2008, 33(11): 1362-1365.
- 9. 李王平, 陈晓霞, 潘蕾, 等. 以胸膜广泛侵犯为表现的结节病一例并文献复习. 中华肺部疾病杂志(电子版), 2017, 10(2): 237-238.
- 10. Rubini G, Cappabianca S, Altini C, et al. Current clinical use of 18 FDG-PET/CT in patients with thoracic and systemic sarcoidosis. Radiol Med, 2014, 119(1): 64-74.
