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Abstract

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Article in Japanese

Case Report

A case of pulmonary sarcoidosis with negative heart sign

Ayumi Suzuki  Naoya Fujino  Taizou Hirano  Koji Murakami  Tsutomu Tamada  Hisatoshi Sugiura 

Department of Respiratory Medicine, Tohoku University Graduate School of Medicine

ABSTRACT

A 39-year-old man presented with dyspnea on exertion and dry cough for three months. Chest computed tomography showed bilateral hilar and mediastinal lymphadenopathy, multiple small granular opacities and areas of ground-glass opacity. Gallium-67 scintigraphy showed diffuse pulmonary uptake greater than the uptake seen over the cardiac area and produced a `negative heart' sign. Bronchoalveolar lavage fluid showed an increase in the percentage of lymphocytes and CD4/CD8 ratio. Histological examination of a transbronchial lung biopsy specimen showed epithelioid cell granulomas. We diagnosed this as pulmonary sarcoidosis and followed up without treatment. The clinical symptoms, radiological findings and restrictive impairment on pulmonary function test worsened after two weeks and were improved by steroid treatment. The negative heart sign was considered to be a characteristic finding of pulmonary sarcoidosis with rapidly progressive respiratory disease.

KEYWORDS

Pulmonary sarcoidosis  Gallium-67 (67Ga) scintigraphy 

Received 14 Jun 2020 / Accepted 15 Oct 2020

AJRS, 10(1): 78-82, 2021

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