Chest
ReviewThe Roentgenographic Staging of Sarcoidosis: Historic and Contemporary Perspectives
Section snippets
Course and Prognosis
Wurm, Reindell, and Heilmeyer14 found the best prognosis in patients with stage I disease, an intermediate prognosis in stage II, and the worst in stage III. In the report of Smellie and Hoyle,22 although they did not use a staging system, one can stage their patients on the basis of the data presented. They observed the natural course of 125 patients for more than two years from the time of discovery. Those presenting with hilar adenopathy alone (stage I) demonstrated spontaneous clearing of
Pulmonary Function
Winterbauer and Hutchinson24 have summarized the significance of pulmonary function testing in sarcoidosis. They noted that 80 percent of patients without roentgenographic evidence of parenchymal sarcoidosis, ie, stage I, had normal vital capacities, and 70 percent had normal diffusing capacities (Dco). With the advent of parenchymal change (stages II and III), only 35 percent had normal vital capacities and 34 percent normal Dcos. DeRemee and Andersen,25 reporting on 107 patients, noted that
Assessing Inflammatory Activity
Pulmonary sarcoidosis begins with an alveolitis composed chiefly of thymus-dependent lymphocytes (T cells).27 These elaborate chemotactic factors which attract monocytes, which ultimately transform into macrophages and epithelioid cells composing the granuloma. The granuloma may resolve either spontaneously or under the influence of glucocorticoids or be transformed into irreversible scar tissue by a process of hyalinization and fibrosis. These phases in the pathogenesis occur over variable
Summary and Conclusions
A large body of literature supports the legitimacy of roentgenographic staging in sarcoidosis. In fact, sarcoidosis is uniquely suited to this concept because of orderly progression on chest roentgenogram, its variable predilection for spontaneous resolution, the degree of pulmonary function changes, and frequency of dyspnea, all of which have been correlated with the chest roentgenogram findings. Some have questioned the validity of the putative, sequential development, since it is often
Acknowledgment
I wish to thank Mrs. Betty Marsh for her help in preparation of the manuscript.
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2018, Joint Bone SpineCitation Excerpt :The results of the intradermal tuberculin test were recorded. Findings from minor salivary gland biopsy, chest radiographs, and chest-computed tomography (CT) were collected when available [27]. A standardized ultrasonography assessment including B-mode and power or color Doppler imaging was performed [28].