ObjectiveTo improve the diagnosis and treatment of multiple systemic sarcoidosis (MSS) and avoid misdiagnosis. MethodsTo analyze the diagnosis and treatment of a MSS patient misdiagnosed as lymphoma. Related literatures were also reviewed. ResultsThe patients' clinical manifestations were not specific including cough and stethocatharsis. Lung and thoracic lymph nodes were most commonly involved in MSS. MSS was characterized by symmetrical lymph nodes enlargement in the bilateral lung hilus and/or mediastinum. The enlarged lymph nodes had a clear boundary and showed homogeneous enhancement. Symmetrical fluorodeoxyglucose (FDG) uptake in the hilar and/or mediastinal node was a typical finding of sarcoidosis on FDG PET/CT. Mucosal inflammation and mucosal nodules could be seen in the bronchoscope. Sarcoidosis was characterized by the presence of noncaseating groanulomas histologically. Hormonal therapy was effective for MSS. ConclusionSarcoidosis is a kind of disease involving multiple systems and organs with unknown etiology. The clinical manifestation of sarcoidosis is nonspecific,so it's likely to be misdiagnosed. Imaging examination and laboratory examination are helpful to the diagnosis of MSS. The definitive diagnosis depends on the pathologic biopsy.
Endobronchial ultrasound guided tranbronchial needle aspiration (EBUS-TBNA) is a new technology developed in the past 10 years. In the USA, EBUS-TBNA has been recommended as an important means for preoperative lymph node staging of lung cancer, and becomes a new standard for mediastinal staging of lung cancer. A large number of clinical data shows that EBUS-TBNA is a novel approach which owes the advantages of accuracy in diagnosis and safety in operating. What's more, its value in the diagnosis of some disease in chest has been widely recognized. The aim of this article is to review the current application of EBUS-TBNA in the diagnosis of early lung cancer, diagnosis and tumor staging of advanced lung cancer, the relationship between EBUS-TBNA and traditional inspection including CT, positron emission tomography/computed tomography (PET) and mediastinoscopy, and the application value of EBUS-TBNA for superior vena cava syndrome and some non-neoplastic diseases.
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.