Chest computed tomography and mediastinoscopy in the diagnosis of sarcoidosis-associated uveitis

doi:10.1016/S0002-9394(98)00081-6

American Journal of Ophthalmology

Volume 126, Issue 1, July 1998, Pages 132-134

https://doi.org/10.1016/S0002-9394(98)00081-6 Get rights and content

Abstract

Purpose: To report the usefulness of chest computed tomography and mediastinoscopy in diagnosing sarcoidosis in elderly patients with uveitis.

Methods: Case reports. Two Caucasian women, aged 73 and 70 years, underwent evaluations for uveitis, which included chest computed tomography and mediastinoscopy.

Results: A chest computed tomographic scan of each woman disclosed mediastinal lymphadenopathy and warranted mediastinal lymph node biopsy by mediastinoscopy. In both patients, histopathologic and microbiologic studies demonstrated sterile noncaseating granulomas consistent with the diagnosis of sarcoidosis.

Conclusions: The diagnosis of sarcoid-associated uveitis in the elderly may be facilitated by chest computed tomography, which may be more sensitive than conventional chest roentgenography. Laboratory studies of biopsied mediastinal nodes obtained by mediastinoscopy can confirm the diagnosis.

Section snippets

Case 1

A 73-year-old Caucasian woman experienced blurred vision in the left eye. Best-corrected visual acuity was RE, 20/20 and LE, 20/30. There was mild anterior chamber and anterior vitreous cellular reaction in both eyes. Laboratory evaluation, including a complete blood cell count, Westergren sedimentation rate, rapid plasma reagin test, hemagglutination treponema pallidum test, serum lysozyme level, and anergy battery test was normal. Chest x-ray was normal (Figure 1, left). Serum angiotensin

Case 2

A 70-year-old Caucasian woman had undergone uncomplicated phacoemulsification and posterior chamber intraocular lens implantation in the right eye and 3 months later, in the left eye. Her visual acuity in each eye deteriorated during the year after the second surgery. Ophthalmologic examination 1 year postoperatively disclosed a best-corrected visual acuity of RE, 20/50 and LE, 20/400. There was moderate anterior vitreous cellular reaction. Laboratory evaluation, including complete blood cell

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Citation Excerpt :
Conventionally, screening has been performed with chest radiography and chest CT scanning used in cases of equivocal chest radiographs or cases with high suspicion on other grounds. Nevertheless, there are data to suggest that chest CT scanning may be superior for the detection of bilateral hilar adenopathy.29,30 Whether chest CT scanning should replace chest radiography as a screening tool is an open question, and the SUN data do not provide a definitive answer.
The purpose of this study was to determine classification criteria for sarcoidosis-associated uveitis.
Machine learning of cases with sarcoid uveitis and 15 other uveitides.
Cases of anterior, intermediate, and panuveitides were collected in an informatics-designed preliminary database, and a final database was constructed including cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were analyzed by anatomic class, and each class was split into a training set and a validation set. Machine learning using multinomial logistic regression was used in the training sets to determine a parsimonious set of criteria that minimized the misclassification rate among the uveitides. The resulting criteria were evaluated in the validation sets.
A total of 1,083 cases of anterior uveitides, 589 cases of intermediate uveitides, and 1,012 cases of panuveitides, including 278 cases of sarcoidosis-associated uveitis, were evaluated by machine learning. Key criteria for sarcoidosis-associated uveitis included a compatible uveitic syndrome of any anatomic class and evidence of sarcoidosis, either 1) tissue biopsy results demonstrating non-caseating granulomata or 2) bilateral hilar adenopathy on chest imaging. The overall accuracy of the diagnosis of sarcoidosis-associated uveitis in the validation set was 99.7% (95% confidence interval: 98.8-99.9). The misclassification rates for sarcoidosis-associated uveitis in the training sets were 3.2% in anterior uveitis, 2.6% in intermediate uveitis, and 1.2% in panuveitis; in the validation sets, the misclassification rates were 0% in anterior uveitis, 0% in intermediate uveitis, and 0% in panuveitis.
The criteria for sarcoidosis-associated uveitis had a low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.
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Brief ReportsChest computed tomography and mediastinoscopy in the diagnosis of sarcoidosis-associated uveitis

Abstract

Section snippets

Case 1

Case 2

Am J Ophthalmol

Ophthalmology

Brief Reports
Chest computed tomography and mediastinoscopy in the diagnosis of sarcoidosis-associated uveitis