Sarcoidosis is a disease of unknown etiology which is characterized pathologically on widespread noncaseating granulomas involving multiple organ theorys We report a case of sarcoidosis presenting as a ventilation-perfusion mismatch onward a lung scan.

Sarcoidosis is a disease of unknown etiology which is characterized pathologically on widespread noncaseating granulomas involving multiple organ theorys We report a case of sarcoidosis presenting as a ventilation-perfusion mismatch onward a lung scan.

Sarcoidosis is greatest in quantity prevalent in young people (20 to 40 years old) and is 12 to 16 times more prevalent in blacks than whites in the United States.[1] The lung and intrathoracic lymph nodes are involved in 90 percent of all cases. The in the greatest degree common array of radiographic findings at the time of initial diagnosis includes bilateral bronchopulmonary, right paratracheal, and aorticopulmonary window lymphadenopathy. We report a case of sarcoidosis presenting as a mismatch forward a ventilation-perfusion lung scan.

CASE REPORT

A 43-year-old black woman with a history of insulin-dependent diabetes, essential hypertension, and hypothyroidism not past nor futureed to the Emergency Department with unforeseen onset of severe substernal chest pain of a small in number hours in duration. The patient was diaphoretic and extremely short of breath.

The pain was relieved with sublingual nitroglycerin, and the patient was admitted to the coronary care unit. A myocardial enzyme profile and following ECG disclosed no abnormalities, confirming that the patient was not having a myocardial infarction. Persistent dyspnea and a cheap [PO.sub.2] value of 60 mm Hg quicked a ventilation-perfusion lung scan to determine the appearance of a pulmonary embolism. The ventilation-perfusion scan demonstrated a ventilation-perfusion mismatch involving the right upper lobe (Fig 1) The scintigraphic findings alone with this clinical history are highly suggestive of a pulmonary embolism. The accompanying chest radiograph demonstrated marked bilateral perihilar and right paratracheal lymphadenopathy (Fig 2) A chest radiograph obtained 3 month earlier was normal with no evidence of mediastinal lymphadenopathy (Fig 3) A comput tomographic scan of the chest was performed the following day to confirm the port and location of the lymphadenopathy prior to mediastinoscopy. Mediastinoscopy with a lymph node biopsy was done forward hospital day 3. Histologic analysis revealed multiple aggregated noncaseating granulomatous lesions (sarcoidosis).

DISCUSSION

A review of the literature revealed solely four reported cases of mediastinal sarcoidosis resulting in extrinsic compression of a pulmonary artery. In these cases, the patients were women between the ages of 25 and 39 years; three of four were black.[2-5] The patients initially readyed with symptoms of progressive shortness of breath and pleuritic chest pain. The diagnosis was established in our case following detection of the ventilation-perfusion mismatch and also was based upon evidence of hilar and mediastinal lymphadenopathy shown on a chest radiograph and a comput tomographic scan of the chest. Mediastinal lymph node biopsy provided the histologic diagnosis. In the other reported cases, the right upper lobe perfusion blemishs were confirmed by a ventilation-perfusion scan.

Patients with sarcoidosis initially ready with a wide variety of signs and symptoms. most numerous commonly, ocular disturbances, enlarged peripheral lymph nodes, skin eruptions, and respiratory symptoms are the reasons that the patient take counsel s a physician.[1] Lung scan abnormalities at initial presentation are unusual, particularly if the abnormalities are attributed solely to mediastinal lymphadenopathy.[6]

The really unique aspect regarding this case is the rapid evolution of mediastinal lymphadenopathy. Three month prior to the attack of symptoms, the patient had a normal chest radiograph and was asymptomatic. To our knowledge, there is no documented case of sarcoidosis developing in similar a relatively rapid time frame.

CONCLUSION

It has been previously documented that massive hilar and right paratracheal adenopathy secondary to sarcoidosis can cause extrinsic compression of pulmonary arteries with following segmental perfusion defects.[2-4] In our case, as in the examples described in the literature, a right upper lobe perfusion deficiency and mediastinal lymphadenopathy were discovered at initial presentation. In the appropriate clinical setting, with this combination of radiographic abnormalities, sarcoidosis should be a diagnostic consideration. The usual longitudinal dimensions of time for the exhibition of sarcoidosis is not well understood or documented. In our case, the marked amount of mediastinal disease that cause to growed in three months time is notable.

REFERENCES

[1] Pare JA, Fraser RG Synopsis of diseases of the chest. Philadelphia: WB Saunders, 1983; 640-44

[2] Faunce HF Ramsay GC Sy W Protracted over and above variable major pulmonary artery compression in sarcoidosis. Radiology 1976; 119:313-14

[3] Hietala in such a manner Stinnett RG, Faunce HF, Sharpe AR, Scoggins WG Smith RH Pulmonary artery narrowing in sarcoidosis. JAMA 1977; 237:572-73

[4] Wescott JL Degraff AC. Sarcoidosis, hilar adenopathy, and pulmonary artery narrowing. Radiology 1973; 108:585-86

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