Clinical Analysis of 14 Cases of Sarcoidosis

Background:Sarcoidosis is a systemic granulomatous disease with unknown etiology.Objectives:To analyze and summarize the clinical characteristics and outcomes of patients with sarcoidosis for accuracy diagnose and treatment of this illness.Methods:Retrospective review of 14 inpatients diagnosed as sarcoidosis at Shandong University Qilu Hospital over a 3-year period(from January,2005 to October,2007).Results:The mean age of fourteen patients is 49.3 years.The ratio of males and females is 3:4.The main symptoms had been presents in respiratory system were cough 85.7%,stethocatharsis 42.9%,shortness of breath 28.6%,bloody sputum 7.1%.Extrapulmonary manifestations were periph lymphadenectasis 28.6%, articulation involved 14.3%,skin involved 14.3%,gastrointestinal symptom 7.1%,nervous system's symptom 7.1%,atrial fibrillation 7.1%.The main constitutional symptoms were fever 28.6%,fatigue 28.6%,night sweat 21.4%.The clinical degree was as follows:stageⅠ50%,stageⅡ42.9%,stageⅢ7.1%.The imaging features were bilateral hilar lymphadenectasis 7.14%,bilateral hilar and intramediastinum lymphadenectasis 7.14%,unilateral hilar lymphadenectasis 7.14%,intramediastinum lymphadenectasis 28.57%,intramediastinum lymphadenectasis and pulmonary parenchymal infiltrates 28.57%,bilateral hilar and intramediastinum lymphadenectasis and pulmonary parenchymal infiltrates 14.30%,pulmonary parenchymal infiltrates 7.14%.35.72%observed nodular in lung,7.14%observed cystic radiolucencies,7.14%had consolidation of lung.21.44%observed pleura involved.All cases' tuberculin test were negative(100%).28.6%had ESR stepped up, 14.3%had sACE to heighten,14.3%had hypercalcaemia,14.3%had lymphocytes ratio stepped up in bronchoalveolar-lavage fluid.2 cases found DLco decreased. Biopsy in cervical and supraclavicular nodes had 3 cases(21.5%),phymata biopsy had 1 case(7.1%),TBLB had 4 cases(28.6%),TBNA had 1 case(7.1%),mediastinal lymph node per mediastinoscopy had 2 case(14.3%),per cuterm lung biopsy had 2 case(14.3%),lung and lymphaden biopsy with surgery had 1 case(7.1%).3 cases(21.5%)misdiagnosed for lung cancer,1 case(7.1%)for lymphadenoma,1 case(7.1%)for tuberculosis.All cases on stageⅡandⅢgave steroids and effective power were 100%.All case on stageⅠmay be observed and 85.7%occurred spontaneous remissions.Conclusions:Clinical symptom of sarcoidosis have respiratory system's manifestations,extrapulmonary manifestations and constitutional symptoms.The imaging features of sarcoidosis are bilateral hilar lymphadenectasis.Hypercalcaemia is typical manifestation of sarcoidosis,sACE is a marker of disease activity.All cases' tuberculin test are negative and this result is used to discriminate sarcoidosis from tuberculosis.DLco is the most sensitive of pulmonary function tests parameters. Sarcoidosis,histologically characterized by the presence of noncaseating groanulomas TBLB is the initial diagnosis procedure of choice in patients with suspected pulmonary sarcoidosis.Mediastinoscopy is important diagnostic instrument in case that diagnosis is difficult to reach.The disease should be differentiated from lung cancer,lymphadenoma,tuberculosis,ect.Patients with stageⅠmay be observed without any treatments.Corticosteroids,usually oral,constitute the first choice of treatment for stageⅡandⅢdisease.