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Abstract

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Article in Japanese

Case Report

A case of pseudoalveolar sarcoidosis diagnosed by video-assisted thoracoscopic surgery

Shu Tagaa  Satsuki Nakamuraa  Yuji Itoha  Takashi Akiyamab  Masashi Yoshiharab  Osamu Nishiyamac 

aDepartment of Respiratory Medicine, Daiyukai General Hospital
bDepartment of Thoracic Surgery, Daiyukai General Hospital
cDepartment of Respiratory Medicine and Allergology, Kinki University Faculty of Medicine

ABSTRACT

An asymptomatic 31-year-old male with patchy infiltrations with air-bronchogram in bilateral upper fields, and bilateral hilar lymphadenopathies on his chest radiograph, was referred in May 2011. The chest computed tomography showed patchy air-space consolidations and small granular opacities in bilateral lungs with mediastinal lymphadenopathies. The positron emission tomography showed increased 18F-2-deoxy-glucose uptake in cervical, mediastinal, and abdominal lymphadenopathies and nodular opacities in bilateral lungs. The serum angiotensin converting enzyme, the soluble IL-2 receptor, the sialyl Lewis X-i, the neuron specific enolase, and the rate of lymphocyte and CD4/CD8 in bronchoalveolar lavage fluid were increased. A diagnosis required that a biopy from the consolidation and mediastinal lymphadenopathy be done with video-assisted thoracoscopy. Because the pathological findings showed epithelioid cell granuloma without caseous necrosis, and also a multinucleated giant cell, he was diagnosed with sarcoidosis. After the treatment of oral corticosteroids (prednisolone 0.5 mg/kg/day, then tapered), the air-space consolidations, small granular opacities, and lymphadenopathies were gradually improved. In conclusion, there are a few reported cases of “pseudoalveolar sarcoidosis” with pseudoalveolar sarcoid lesions by small granular opacities accumulation in alveolar spaces; therefore sarcoidosis should be considered as one of the differential diagnoses when chest computed tomography shows air-space consolidations and small granular opacities.

KEYWORDS

Pseudoalveolar sarcoidosis  Air-space consolidation  Video-assisted thoracoscopic surgery 

Received 3 Aug 2011 / Accepted 13 Jan 2012

AJRS, 1(4): 349-353, 2012

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