Sarcoidosis: A truly protean disease

Sarcoidosis is a multisystem disease, the activity of the disease process can be ascertained by determining the angiotension levels in blood. This also can be achieved by ⁶⁷Ga scintigraphy that will inform about different areas of localisation of the disease process. ⁶⁷Ga-scintigraphy is also useful in the follow-up of patients with sarcoidosis and to evaluate the response to therapy.     

Sarcoidosis: a truly protean disease

Sarcoidosis is a multisystem disease, the activity of the disease process can be ascertained by determining the angiotension levels in blood. This also can be achieved by 67Ga scintigraphy that will inform about different areas of localisation of the disease process. 67Ga-scintigraphy is also useful in the follow-up of patients with sarcoidosis and to evaluate the response to therapy.     

Sarcoidosis: assessment of disease severity using HRCT

The value of high-resolution computed tomography (HRCT) in diagnosing and assessing inflammatory activity in sarcoidosis is well established. The aim of the present study was to address the intra- and inter-observer agreements of the HRCT score by Oberstein et al. [8], and to evaluate the relationship between HRCT findings and disease severity expressed in respiratory functional impairment in sarcoidosis. The clinical records of 80 known sarcoidosis patients visiting the outpatient clinic between January 2000 and August 2001, who underwent a HRCT as well as lung function tests (including exercise testing), were reviewed. Two readers scored the first 60 HRCT images twice. Weighted kappa and intra-class correlation coefficient were used to assess the reliability of the HRCT scoring system. Spearman's rank correlation coefficients and multiple regression analyses were performed to evaluate the relationship between HRCT findings (first reading, reader A) and respiratory functional impairment. Intra- and inter-reader reliability demonstrated good agreement. All HRCT subscores, except enlargement of lymph nodes, were correlated to the FEV₁, FVC, DLco, Pao₂max (all p<0.05) and A-aPo₂ max (p<0.001). Furthermore, HRCT abnormalities, but not the chest radiographic stage, were strongly associated with functional parameters. Abnormal changes of lung parenchyma, established by HRCT features, were associated with respiratory functional impairment in sarcoidosis. Moreover, compared with the radiographic stages, HRCT findings appeared to be much more sensitive in depicting respiratory disability, especially abnormal gas exchange.     

Sarcoidosis: a primer

Sarcoidosis is an enigmatic disease with high variability in its manifestation within the body. Associated granulomas can form in many different parts of the body and can affect multiple organs. Some patients affected by this multiorgan disease never require treatment, while others require comprehensive long-term care and follow-up. Familiarity with the clinical and radiologic features of sarcoidosis is key to understanding how physicians diagnose and manage the disease. Further research is needed to comprehend the relationship between sarcoidosis and malignant neoplasms. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your area of interest. For access to other quizzes, go to www.asrt.org/store.     

Inside the lungs of COVID-19 disease

In the setting of the coronavirus disease 2019 (COVID-19) pandemic, only few data regarding lung pathology induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is available, especially without medical intervention interfering with the natural evolution of the disease. We present here the first case of forensic autopsy of a COVID-19 fatality occurring in a young woman, in the community. Diagnosis was made at necropsy and lung histology showed diffuse alveolar damage, edema, and interstitial pneumonia with a geographically heterogeneous pattern, mostly affecting the central part of the lungs. This death related to COVID-19 pathology highlights the heterogeneity and severity of central lung lesions after natural evolution of the disease.     

Kimura's disease: clinical and imaging parameters for the prediction of disease recurrence

Kimura's disease is a rare chronic inflammatory disorder with a high rate of recurrence. The clinical and imaging features of Kimura's disease have been documented in the literature, but the relationship between these features and disease recurrence is still unclear. We conclude that disease duration of greater than 5 years, bilateral involvement, a lesion diameter of greater than 3 cm, a blood eosinophil count greater than 20%, and ill-defined lesions are predictive factors for the recurrence of Kimura's disease.     

肺结节病1例报告

患者　男,5 4岁。于45d前出现发热,每日下午开始,持续4h后退热,最高可达3 9.2℃,咳嗽剧烈,影响夜间睡眠,咳大量白色泡沫状痰,且痰中带血,伴胸痛、气短,无乏力、盗汗等症状,曾给予抗感染(不详)治疗症状无缓解。胸部CT片示:两肺门旁可见蝶冀状致密影,其边缘可见斑片状、结节状及索条影,边界不清(图1) ,双肺门及纵隔内淋巴结肿大并融合(图2 )。CT诊断:两肺门旁大片致密影,结节病可能。于CT引导下穿刺活检,病理诊断:纤维组织内淋巴细胞为主炎性浸润,内有小灶状上皮细胞重度增生,未见瘤细胞(图3 )。图1　两肺内旁见蝶冀状致密影,边缘模糊,可见…     

Analysis of the recurrence pattern in Hodgkin's disease

The data published about the healing chances of Hodgkin's disease cannot reflect reality since the evaluation includes also the technically preventable marginal recurrences. The analysis of 63 own cases furnishes the same result as far as only one true recurrence was found in the irradiated regions. Only in two patients we have seen a progression of the disease in lymph nodes beyond the extended field. The evaluation of our recurrences shows a clear pattern: in the individual cases, progression during radiotherapy and recurrences are very probably due to an understaging or to a problem concerning the dose.     

Isolated pleural recurrence of Hodgkin's disease

Relapses of Hodgkin's disease are predominantly nodal or systemic. An extranodal manifestation is a rare exception. We report on a patient who developed an isolated pleural relapse at the margin of the irradiation field after successful radiotherapy of a Hodgkin's disease stage I.     

MRI patterns in recurrence of primary CNS lymphoma in immunocompetent patients

Purpose

Primary CNS lymphomas (PCNSL) are highly malignant non-Hodgkin's B-cell lymphoma restricted to the CNS. While MRI features of PCNSL at initial presentation have been comprehensively described, literature on MRI-characteristics at relapse is sparse. The purpose of this study was to investigate anatomic location and contrast enhancement patterns at PCNSL recurrence by cranial MRI.

Methods

Sixteen immunocompetent patients (9 men, 7 women, median age 65 years) with histologically proven PCNSL and initial response to a standardized polychemotherapy, but suffering from a relapse were consecutively recorded. Native and contrast-enhanced MRI examinations carried out at initial presentation and at time of relapse were compared. Anatomical site of parenchymal enhancement, frequency and presence of non-parenchymal contrast enhancement (i.e. ventricular, superficial, subependymal) patterns at initial presentation and at relapse were recorded and compared.

Results

Local recurrence was found at the site of the initial tumor presentation in four of the 16 cases. Six of 11 patients presenting a unilateral PCNSL at initial presentation had a bilateral involvement at relapse. In two cases, recurrence appeared solely on the contralateral side without involvement of the hemisphere initially affected. At both dates, subependymal enhancement was the most often found non-parenchymal pattern (six at initial presentation, and five at relapse). The number of patients with a ventricular contrast enhancement increased from one at initial presentation to four at relapse.

Conclusions

PCNSL tend to recur in different parenchymal anatomic sites as compared with the site of the initial tumor presentation. Contrast-enhancing non-parenchymal lesions are also frequent and might change their pattern at relapse.