Figures
- Fig. 1—
Computed tomography scan of the lower lung zones showing bilateral airspace consolidation.
- Fig. 2—
Computed tomography scan at the level of the right bronchus intermedius showing small airway disease in the right upper lobe with areas of airspace consolidation in the lingula and the apical segment of the left lower lobe. The peripheral location of the axillary mass with irregular borders should be noted.
- Fig. 3—
Computed tomography scan at the level of the right bronchus intermedius, showing three nodular opacities with irregular borders, one located in the lingula and one located in the left lower lobe. The presence of areas of ground-glass attenuation in the posterior parts of both lower lobes corresponds to hypoventilated lung.
- Fig. 4—
Computed tomography scan at the level of the right bronchus intermedius, showing large areas of airspace consolidation in the right middle lobe, lingula and the apical segments of both lower lobes. The presence of cavitation within the right and left lower lobe masses should be noted.
- Fig. 5—
Histological stain showing coagulative necrosis and individual granulomas.
- Fig. 6—
Histological stain showing vascular involvement with extensive granulomatous infiltration of the media.
Tables
- Table. 1—
Clinical features at time of diagnosis in 14 necrotising sarcoid granulomatosis patients
Features Patients Smoking habits Nonsmokers 9 (64) Ex-smokers 1 (7) Smokers 4 (29) Respiratory manifestations 8 (57) Cough 5 (36) Dyspnoea 4 (29) Exertional 4 (29) At rest 0 (0) Chest pain 4 (29) Extrarespiratory manifestations 12 (86) Systemic symptoms 8 (57) Easily tired 7 (50) Fever 5 (36) Weight loss 4 (29) Night sweats 2 (14) Arthralgia 5 (36) Ocular manifestations 3 (21) Sicca syndrome 2 (14) Neurological symptoms 1 (7) Nasal symptoms 1 (7) Skin involvement 1 (7) Physical findings Crackles 1 (7) Joint swelling 1 (7) Splenomegaly 1 (7) Data are presented as n (%).
- Table. 2—
Results of pulmonary function tests in 14 patients with necrotising sarcoid granulomatosis
Patient No. FEV1 L (% pred) FVC L (% pred) FEV1/FVC % pred TLC L (% pred) RV L (% pred) RV/TLC % pred DL,CO/VA % pred 1 3.1 (118) 3.9 (125) 80 5.2 (110) 1.3 (85) 25 74 2 2.6 (80) 3.0 (80) 82 5.6 (104) 2.6 (160) 46 105 3 2.8 (82) 3.1 (92) 86 4.3 (82) 1.1 (82) 26 109 4 3.8 (102) 4.7 (101) 82 6.3 (88) 1.1 (52) 18 74 5 2.6 (111) 3.0 (109) 86 5.0 (99) 2.1 (110) 42 74 6 2.3 (78) 3.0 (80) 76 5.4 (83) 1.7 (95) 31 78 7 3.1 (88) 3.2 (89) 95 4.3 (91) 1.1 (109) 25 83 8 3.3 (116) 3.4 (95) 96 6.2 (98) 2.8 (116) 45 60 9 2.3 (80) 2.7 (83) 84 4.1 (85) 1.3 (87) 32 74 10 2.2 (91) 2.6 (101) 76 4.3 (103) 1.4 (90) 32 NA 11 2.1 (91) 2.6 (95) 81 5.5 (106) 2.1 (101) 38 NA 12 1.8 (52) 2.7 (62) 69 5.2 (79) 2.7 (134) 52 74 13 3.0 (110) 3.5 (113) 86 6.1 (123) 2.6 (150) 43 71 14 3.5 (84) 3.9 (74) 84 NA NA NA NA FEV1: forced expiratory volume in one second; % pred: percentage of predicted; FVC: forced vital capacity; TLC: total lung capacity; RV: residual volume; DL,CO: carbon monoxide diffusing capacity of the lung; VA: alveolar volume; NA: not available.
- Table. 3—
Computed tomography findings in 14 patients with necrotising sarcoid granulomatosis
Finding Patients Infiltrates 7 (50) Solitary nodule 4 (29) Bilateral/multiple nodules 3 (21) Cavitation 2 (14) Hilar or mediastinal adenopathy 5 (36)# Pleural thickening 1 (7) Data are presented as n (%). #: bilateral in all cases.
- Table. 4—
Examination of bronchoalveolar lavage samples in eight patients with necrotising sarcoid granulomatosis
Patient No. 103 cells·mL−1 Macrophage % Lymphocyte % Neutrophil % Eosinophil % 1 192 90 8 2 0 2 180 93 6 1 0 4 38 92.5 5 2.5 0 5 150 82 6 12 0 6 375 90 2 8 0 7 240 60 37 3 0 8 229 82 14 1 3 10 88 64 32 4 0 - Table. 5—
Treatment and clinical course in 14 patients with necrotising sarcoid granulomatosis
Patient No. Treatment Indication Respiratory course Extrarespiratory course Follow-up months 1 Steroid Systemic symptoms Resolution relapse Resolution 60 2 Steroid Arthralgia Resolution relapse# Persistent arthralgia 102 3 None Resolution Resolution 32 4 Surgery Diagnostic procedure Resolution Resolution 21 5 Steroid Systemic symptoms Resolution relapse Resolution 101 6 S, C#, A, EI Cerebral involvement Resolution Death (neurological) 114 7 Steroid Systemic symptoms Resolution Resolution 28 8 Surgery Diagnostic procedure Relapse of nodule None 42 9 None Resolution Resolution 18 10 Surgery Diagnostic procedure Relapse of nodules Pericarditis C-myopathy 36 11 Surgery Diagnostic procedure Resolution None 24 12 None Sequelar cavities¶ Resolution 56 13 None Resolution Resolution 52 14 None Resolution Persistence of skin lesions 79 S: steroid; C: cyclophosphamide; A: azathioprine; EI: encephalic irradiation. #: neoplasy occurrence; ¶: aspergilloma and lung cancer.
