Pulmonary Sarcoidosis

Joseph P. Lynch; Yan Ling Ma; Michael N. Koss; Eric S. White

doi:10.1055/s-2007-970333

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2007; 28(1): 053-074
DOI: 10.1055/s-2007-970333

Pulmonary Sarcoidosis

Joseph P. Lynch¹ III , Yan Ling Ma² , Michael N. Koss² , Eric S. White³

¹Division of Pulmonary, Critical Care Medicine, and Hospitalists, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
²Department of Pathology, Keck School of Medicine, University of Southern California (USC) Los Angeles, California
³Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan

Abstract

ABSTRACT

Sarcoidosis, a granulomatous disorder of unknown etiology, characteristically involves multiple organs. However, pulmonary manifestations typically dominate. Chest radiographs are abnormal in 85 to 95% of patients. Abnormalities in pulmonary function tests are common and may be associated with cough, dyspnea, and exercise limitation. However, one third or more of patients are asymptomatic, with incidental abnormalities on chest radiographs. The clinical course and expression of pulmonary sarcoidosis are variable. Spontaneous remissions occur in nearly two thirds of patients. The course is chronic in up to 30% of patients. Chronic pulmonary sarcoidosis may result in progressive (sometimes life-threatening) loss of lung function. Fatalities ascribed to sarcoidosis occur in 1 to 4% of patients. Although the impact of treatment is controversial, corticosteroids may be highly effective in some patients. Immunosuppressive, cytotoxic, or immunomodulatory agents are reserved for patients failing or experiencing adverse effects from corticosteroids. Lung transplantation is a viable option for patients with life-threatening disease failing medical therapy.

KEYWORDS

Pulmonary sarcoidosis - nonnecrotizing granuloma - necrotizing sarcoid angiitis

Full Text

References

REFERENCES

1 Lynch III J P, Baughman R, Sharma O. Extrapulmonary sarcoidosis. Semin Respir Infect. 1998; 13 229-254
2 Newman L S, Rose C S, Maier L A. Sarcoidosis. N Engl J Med. 1997; 336 1224-1234
3 Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med. 1999; 160 736-755
4 Johns C J, Michele T M. The clinical management of sarcoidosis: a 50-year experience at the Johns Hopkins Hospital. Medicine (Baltimore). 1999; 78 65-111
5 Lynch III J P, Kazerooni E A, Gay S E. Pulmonary sarcoidosis. Clin Chest Med. 1997; 18 755-785
6 Baughman R P, Teirstein A S, Judson M A et al.. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med. 2001; 164(10 Pt 1) 1885-1889
7 Neville E, Walker A, James D G. Prognostic factors predicting the outcome of sarcoidosis: an analysis of 818 patients. Q J Med. 1983; 52(208) 525-533
8 Romer F K. Presentation of sarcoidosis and outcome of pulmonary changes. Dan Med Bull. 1982; 29 27-32
9 Scadding J G. Prognosis of intrathoracic sarcoidosis in England: a review of 136 cases after five years' observation. BMJ. 1961; 2 1165-1172
10 Hillerdal G, Nou E, Osterman K, Schmekel B. Sarcoidosis: epidemiology and prognosis: a 15-year European study. Am Rev Respir Dis. 1984; 130 29-32
11 Henke C E, Henke G, Elveback L R, Beard C M, Ballard D J, Kurland L T. The epidemiology of sarcoidosis in Rochester, Minnesota: a population-based study of incidence and survival. Am J Epidemiol. 1986; 123 840-845
12 Bechtel J J, Starr III T, Dantzker D R, Bower J S. Airway hyperreactivity in patients with sarcoidosis. Am Rev Respir Dis. 1981; 124 759-761
13 Reich J M, Johnson R E. Course and prognosis of sarcoidosis in a nonreferral setting: analysis of 86 patients observed for 10 years. Am J Med. 1985; 78 61-67
14 Reich J M. Mortality of intrathoracic sarcoidosis in referral vs population-based settings: influence of stage, ethnicity, and corticosteroid therapy. Chest. 2002; 121 32-39
15 Judson M A, Baughman R P, Thompson B W et al.. Two year prognosis of sarcoidosis: the ACCESS experience. Sarcoidosis Vasc Diffuse Lung Dis. 2003; 20 204-211
16 Baughman R P, Winget D B, Bowen E H, Lower E E. Predicting respiratory failure in sarcoidosis patients. Sarcoidosis Vasc Diffuse Lung Dis. 1997; 14 154-158
17 Huang C T, Heurich A E, Sutton A L, Lyons H A. Mortality in sarcoidosis: a changing pattern of the causes of death. Eur J Respir Dis. 1981; 62 231-238
18 Perry A, Vuitch F. Causes of death in patients with sarcoidosis: a morphologic study of 38 autopsies with clinicopathologic correlations. Arch Pathol Lab Med. 1995; 119 167-172
19 Siltzbach L E, James D G, Neville E et al.. Course and prognosis of sarcoidosis around the world. Am J Med. 1974; 57 847-852
20 Gribbin J, Hubbard R B, Le Jeune I, Smith C J, West J, Tata L J. The incidence and mortality of idiopathic pulmonary fibrosis and sarcoidosis in the UK. Thorax. 2006; 61 980-985
21 Yamamoto M, Kosuda T, Yanagawa H et al.. Long-term follow-up in sarcoidosis in Japan. Z Erkr Atmungsorgane. 1977; 149 191-196
22 Israel H L, Karlin P, Menduke H, DeLisser O G. Factors affecting outcome of sarcoidosis. Influence of race, extrathoracic involvement, and initial radiologic lung lesions. Ann NY Acad Sci. 1986; 465 609-618
23 Johns C J, Schonfeld S A, Scott P P, Zachary J B, MacGregor M I. Longitudinal study of chronic sarcoidosis with low-dose maintenance corticosteroid therapy: outcome and complications. Ann NY Acad Sci. 1986; 465 702-712
24 Siltzbach L E. Sarcoidosis: clinical features and management. Med Clin North Am. 1967; 51 483-502
25 Gottlieb J E, Israel H L, Steiner R M, Triolo J, Patrick H. Outcome in sarcoidosis: the relationship of relapse to corticosteroid therapy. Chest. 1997; 111 623-631
26 Gideon N M, Mannino D M. Sarcoidosis mortality in the United States 1979-1991: an analysis of multiple-cause mortality data. Am J Med. 1996; 100 423-427
27 Iwai K, Takemura T, Kitaichi M, Kawabata Y, Matsui Y. Pathological studies on sarcoidosis autopsy, II: Early change, mode of progression and death pattern. Acta Pathol Jpn. 1993; 43 377-385
28 Lynch III J P, Wurfel M, Flaherty K et al.. Usual interstitial pneumonia. Semin Respir Crit Care Med. 2001; 22 357-387
29 De Vries J, Rothkrantz-Kos S, van Dieijen-Visser M P, Drent M. The relationship between fatigue and clinical parameters in pulmonary sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2004; 21 127-136
30 Wirnsberger R M, de Vries J, Breteler M H, van Heck G L, Wouters E F, Drent M. Evaluation of quality of life in sarcoidosis patients. Respir Med. 1998; 92 750-756
31 Bergin C J, Bell D Y, Coblentz C L et al.. Sarcoidosis: correlation of pulmonary parenchymal pattern at CT with results of pulmonary function tests. Radiology. 1989; 171 619-624
32 Brauner M W, Grenier P, Mompoint D, Lenoir S, de Cremoux H. Pulmonary sarcoidosis: evaluation with high-resolution CT. Radiology. 1989; 172 467-471
33 Cetinkaya E, Yildiz P, Altin S, Yilmaz V. Diagnostic value of transbronchial needle aspiration by Wang 22-gauge cytology needle in intrathoracic lymphadenopathy. Chest. 2004; 125 527-531
34 Lynch III J P. Computed tomographic scanning in sarcoidosis. Semin Respir Crit Care Med. 2003; 24 393-418
35 Packe G E, Ayres J G, Citron K M, Stableforth D E. Large lung bullae in sarcoidosis. Thorax. 1986; 41 792-797
36 Zar H J, Cole R P. Bullous emphysema occurring in pulmonary sarcoidosis. Respiration. 1995; 62 290-293
37 Biem J, Hoffstein V. Aggressive cavitary pulmonary sarcoidosis. Am Rev Respir Dis. 1991; 143 428-430
38 Ichikawa Y, Fujimoto K, Shiraishi T, Oizumi K. Primary cavitary sarcoidosis: high-resolution CT findings. AJR Am J Roentgenol. 1994; 163 745
39 Israel H L, Lenchner G S, Atkinson G W. Sarcoidosis and aspergilloma: the role of surgery. Chest. 1982; 82 430-432
40 Tomlinson J R, Sahn S A. Aspergilloma in sarcoid and tuberculosis. Chest. 1987; 92 505-508
41 Lewis M M, Mortelliti M P, Yeager Jr H, Tsou E. Clinical bronchiectasis complicating pulmonary sarcoidosis: case series of seven patients. Sarcoidosis Vasc Diffuse Lung Dis. 2002; 19 154-159
42 Mana J, Gomez-Vaquero C, Montero A et al.. Löfgren's syndrome revisited: a study of 186 patients. Am J Med. 1999; 107 240-245
43 Gibson G J, Prescott R J, Muers M F et al.. British Thoracic Society Sarcoidosis study: effects of long term corticosteroid treatment. Thorax. 1996; 51 238-247
44 Hunninghake G W, Gilbert S, Pueringer R et al.. Outcome of the treatment for sarcoidosis. Am J Respir Crit Care Med. 1994; 149(4 Pt 1) 893-898
45 Chappell A G, Cheung W Y, Hutchings H A. Sarcoidosis: a long-term follow-up study. Sarcoidosis Vasc Diffuse Lung Dis. 2000; 17 167-173
46 Nagai S, Shigematsu M, Hamada K, Izumi T. Clinical courses and prognoses of pulmonary sarcoidosis. Curr Opin Pulm Med. 1999; 5 293-298
47 Mana J, Salazar A, Manresa F. Clinical factors predicting persistence of activity in sarcoidosis: a multivariate analysis of 193 cases. Respiration. 1994; 61 219-225
48 Pietinalho A, Ohmichi M, Lofroos A B, Hiraga Y, Selroos O. The prognosis of pulmonary sarcoidosis in Finland and Hokkaido, Japan: a comparative five-year study of biopsy-proven cases. Sarcoidosis Vasc Diffuse Lung Dis. 2000; 17 158-166
49 Grunewald J, Eklund A, Olerup O. Human leukocyte antigen class I alleles and the disease course in sarcoidosis patients. Am J Respir Crit Care Med. 2004; 169 696-702
50 Pasturenzi L, Martinetti M, Cuccia M, Cipriani A, Semenzato G, Luisetti M. HLA class I, II, and III polymorphism in Italian patients with sarcoidosis: the Pavia-Padova Sarcoidosis Study Group. Chest. 1993; 104 1170-1175
51 Ina Y, Takada K, Yamamoto M, Morishita M, Senda Y, Torii Y. HLA and sarcoidosis in the Japanese. Chest. 1989; 95 1257-1261
52 Lenhart K, Kolek V, Bartova A. HLA antigens associated with sarcoidosis. Dis Markers. 1990; 8 23-29
53 Gran J T, Bohmer E. Acute sarcoid arthritis: a favourable outcome? A retrospective survey of 49 patients with review of the literature. Scand J Rheumatol. 1996; 25 70-73
54 Sider L, Horton Jr E S. Hilar and mediastinal adenopathy in sarcoidosis as detected by computed tomography. J Thorac Imaging. 1990; 5 77-80
55 Hennebicque A S, Nunes H, Brillet P Y, Moulahi H, Valeyre D, Brauner M W. CT findings in severe thoracic sarcoidosis. Eur Radiol. 2005; 15 23-30
56 Nishimura K, Itoh H, Kitaichi M, Nagai S, Izumi T. CT and pathological correlation of pulmonary sarcoidosis. Semin Ultrasound CT MR. 1995; 16 361-370
57 Brauner M W, Lenoir S, Grenier P, Cluzel P, Battesti J P, Valeyre D. Pulmonary sarcoidosis: CT assessment of lesion reversibility. Radiology. 1992; 182 349-354
58 Abehsera M, Valeyre D, Grenier P, Jaillet H, Battesti J P, Brauner M W. Sarcoidosis with pulmonary fibrosis: CT patterns and correlation with pulmonary function. AJR Am J Roentgenol. 2000; 174 1751-1757
59 Muller N L, Miller R R. Ground-glass attenuation, nodules, alveolitis, and sarcoid granulomas. Radiology. 1993; 189 31-32
60 Remy-Jardin M, Giraud F, Remy J, Copin M C, Gosselin B, Duhamel A. Importance of ground-glass attenuation in chronic diffuse infiltrative lung disease: pathologic-CT correlation. Radiology. 1993; 189 693-698
61 Murdoch J, Muller N L. Pulmonary sarcoidosis: changes on follow-up CT examination. AJR Am J Roentgenol. 1992; 159 473-477
62 Mana J, Teirstein A S, Mendelson D S, Padilla M L, DePalo L R. Excessive thoracic computed tomographic scanning in sarcoidosis. Thorax. 1995; 50 1264-1266
63 Alhamad E H, Lynch III J P, Martinez F J. Pulmonary function tests in interstitial lung disease: what role do they have?. Clin Chest Med. 2001; 22 715-750 ix
64 Sharma O P, Johnson R. Airway obstruction in sarcoidosis: a study of 123 nonsmoking black American patients with sarcoidosis. Chest. 1988; 94 343-346
65 Sharma O P. Pulmonary sarcoidosis and corticosteroids. Am Rev Respir Dis. 1993; 147(6 Pt 1) 1598-1600
66 Subramanian I, Flaherty K, Martinez F. Pulmonary function testing in sarcoidosis. In: Baughman RP Sarcoidosis. New York; Taylor and Francis Group 2006 210: 415-433
67 Dunn T L, Watters L C, Hendrix C, Cherniack R M, Schwarz M I, King Jr T E. Gas exchange at a given degree of volume restriction is different in sarcoidosis and idiopathic pulmonary fibrosis. Am J Med. 1988; 85 221-224
68 Harrison B D, Shaylor J M, Stokes T C, Wilkes A R. Airflow limitation in sarcoidosis: a study of pulmonary function in 107 patients with newly diagnosed disease. Respir Med. 1991; 85 59-64
69 McCann B G, Harrison B D. Bronchiolar narrowing and occlusion in sarcoidosis: correlation of pathology with physiology. Respir Med. 1991; 85 65-67
70 Stjernberg N, Thunell M. Pulmonary function in patients with endobronchial sarcoidosis. Acta Med Scand. 1984; 215 121-126
71 Benatar S R, Clark T J. Pulmonary function in a case of endobronchial sarcoidosis. Am Rev Respir Dis. 1974; 110 490-496
72 Udwadia Z F, Pilling J R, Jenkins P F, Harrison B D. Bronchoscopic and bronchographic findings in 12 patients with sarcoidosis and severe or progressive airways obstruction. Thorax. 1990; 45 272-275
73 Chambellan A, Turbie P, Nunes H, Brauner M, Battesti J P, Valeyre D. Endoluminal stenosis of proximal bronchi in sarcoidosis: bronchoscopy, function, and evolution. Chest. 2005; 127 472-481
74 Carrington C B. Structure and function in sarcoidosis. Ann NY Acad Sci. 1976; 278 265-283
75 Miller A, Brown L K, Sloane M F, Bhuptani A, Teirstein A S. Cardiorespiratory responses to incremental exercise in sarcoidosis patients with normal spirometry. Chest. 1995; 107 323-329
76 Radwan L, Grebska E, Koziorowski A. Small airways function in pulmonary sarcoidosis. Scand J Respir Dis. 1978; 59 37-43
77 Levinson R S, Metzger L F, Stanley N N et al.. Airway function in sarcoidosis. Am J Med. 1977; 62 51-59
78 Lenique F, Brauner M W, Grenier P, Battesti J P, Loiseau A, Valeyre D. CT assessment of bronchi in sarcoidosis: endoscopic and pathologic correlations. Radiology. 1995; 194 419-423
79 Lavergne F, Clerici C, Sadoun D, Brauner M, Battesti J P, Valeyre D. Airway obstruction in bronchial sarcoidosis: outcome with treatment. Chest. 1999; 116 1194-1199
80 Gleeson F V, Traill Z C, Hansell D M. Evidence of expiratory CT scans of small-airway obstruction in sarcoidosis. AJR Am J Roentgenol. 1996; 166 1052-1054
81 Viskum K, Vestbo J. Vital prognosis in intrathoracic sarcoidosis with special reference to pulmonary function and radiological stage. Eur Respir J. 1993; 6 349-353
82 Ohrn M B, Skold C M, van Hage-Hamsten M, Sigurdardottir O, Zetterstrom O, Eklund A. Sarcoidosis patients have bronchial hyperreactivity and signs of mast cell activation in their bronchoalveolar lavage. Respiration. 1995; 62 136-142
83 Manresa Presas F, Romero Colomer P, Rodriguez Sanchon B. Bronchial hyperreactivity in fresh stage I sarcoidosis. Ann NY Acad Sci. 1986; 465 523-529
84 Mihailovic-Vucinic V, Zugic V, Videnovic-Ivanov J. New observations on pulmonary function changes in sarcoidosis. Curr Opin Pulm Med. 2003; 9 436-441
85 Delobbe A, Perrault H, Maitre J et al.. Impaired exercise response in sarcoid patients with normal pulmonary function. Sarcoidosis Vasc Diffuse Lung Dis. 2002; 19 148-153
86 Wirnsberger R M, Drent M, Hekelaar N et al.. Relationship between respiratory muscle function and quality of life in sarcoidosis. Eur Respir J. 1997; 10 1450-1455
87 Brancaleone P, Perez T, Robin S, Neviere R, Wallaert B. Clinical impact of inspiratory muscle impairment in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2004; 21 219-227
88 Baydur A, Alsalek M, Louie S G, Sharma O P. Respiratory muscle strength, lung function, and dyspnea in patients with sarcoidosis. Chest. 2001; 120 102-108
89 Sietsema K E, Kraft M, Ginzton L, Sharma O P. Abnormal oxygen uptake responses to exercise in patients with mild pulmonary sarcoidosis. Chest. 1992; 102 838-845
90 Karetzky M, McDonough M. Exercise and resting pulmonary function in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 1996; 13 43-49
91 Bradvik I, Wollmer P, Blom-Bulow B, Albrechtsson U, Jonson B. Lung mechanics and gas exchange during exercise in pulmonary sarcoidosis. Chest. 1991; 99 572-578
92 Medinger A E, Khouri S, Rohatgi P K. Sarcoidosis: the value of exercise testing. Chest. 2001; 120 93-101
93 Barros W G, Neder J A, Pereira C A, Nery L E. Clinical, radiographic and functional predictors of pulmonary gas exchange impairment at moderate exercise in patients with sarcoidosis. Respiration. 2004; 71 367-373
94 Lamberto C, Nunes H, Le Toumelin P, Duperron F, Valeyre D, Clerici C. Membrane and capillary blood components of diffusion capacity of the lung for carbon monoxide in pulmonary sarcoidosis: relation to exercise gas exchange. Chest. 2004; 125 2061-2068
95 Young R L, Lordon R E, Krumholz R A, Harkleroad L E, Branam G E, Weg J G. Pulmonary sarcoidosis, I: Pathophysiologic correlations. Am Rev Respir Dis. 1968; 97 997-1008
96 Young Jr R C, Carr C, Shelton T G et al.. Sarcoidosis: relationship between changes in lung structure and function. Am Rev Respir Dis. 1967; 95 224-238
97 Huang C T, Heurich A E, Rosen Y, Moon S, Lyons H A. Pulmonary sarcoidosis: roentgenographic, functional, and pathologic correlations. Respiration. 1979; 37 337-345
98 Winterbauer R H, Hutchinson J F. Use of pulmonary function tests in the management of sarcoidosis. Chest. 1980; 78 640-647
99 McLoud T C, Epler G R, Gaensler E A, Burke G W, Carrington C B. A radiographic classification for sarcoidosis: physiologic correlation. Invest Radiol. 1982; 17 129-138
100 Lin Y H, Haslam P L, Turner-Warwick M. Chronic pulmonary sarcoidosis: relationship between lung lavage cell counts, chest radiograph, and results of standard lung function tests. Thorax. 1985; 40 501-507
101 Muller N L, Mawson J B, Mathieson J R, Abboud R, Ostrow D N, Champion P. Sarcoidosis: correlation of extent of disease at CT with clinical, functional, and radiographic findings. Radiology. 1989; 171 613-618
102 Nugent K M, Peterson M W, Jolles H, Monick M M, Hunninghake G W. Correlation of chest roentgenograms with pulmonary function and bronchoalveolar lavage in interstitial lung disease. Chest. 1989; 96 1224-1227
103 Remy-Jardin M, Giraud F, Remy J, Wattinne L, Wallaert B, Duhamel A. Pulmonary sarcoidosis: role of CT in the evaluation of disease activity and functional impairment and in prognosis assessment. Radiology. 1994; 191 675-680
104 Muers M F, Middleton W G, Gibson G J et al.. A simple radiographic scoring method for monitoring pulmonary sarcoidosis: relations between radiographic scores, dyspnoea grade and respiratory function in the British Thoracic Society Study of Long-Term Corticosteroid Treatment. Sarcoidosis Vasc Diffuse Lung Dis. 1997; 14 46-56
105 Oberstein A, von Zitzewitz H, Schweden F, Muller-Quernheim J. Noninvasive evaluation of the inflammatory activity in sarcoidosis with high-resolution computed tomography. Sarcoidosis Vasc Diffuse Lung Dis. 1997; 14 65-72
106 Drent M, De Vries J, Lenters M et al.. Sarcoidosis: assessment of disease severity using HRCT. Eur Radiol. 2003; 13 2462-2471
107 Hansell D M, Milne D G, Wilsher M L, Wells A U. Pulmonary sarcoidosis: morphologic associations of airflow obstruction at thin-section CT. Radiology. 1998; 209 697-704
108 Akira M, Kozuka T, Inoue Y, Sakatani M. Long-term follow-up CT scan evaluation in patients with pulmonary sarcoidosis. Chest. 2005; 127 185-191
109 Finkel R, Teirstein A S, Levine R, Brown L K, Miller A. Pulmonary function tests, serum angiotensin-converting enzyme levels, and clinical findings as prognostic indicators in sarcoidosis. Ann NY Acad Sci. 1986; 465 665-671
110 Keogh B A, Hunninghake G W, Line B R, Crystal R G. The alveolitis of pulmonary sarcoidosis: evaluation of natural history and alveolitis-dependent changes in lung function. Am Rev Respir Dis. 1983; 128 256-265
111 Lieberman J, Schleissner L A, Nosal A, Sastre A, Mishkin F S. Clinical correlations of serum angiotensin-converting enzyme (ACE) in sarcoidosis: a longitudinal study of serum ACE, 67gallium scans, chest roentgenograms, and pulmonary function. Chest. 1983; 84 522-528
112 Johns C J, Macgregor M I, Zachary J B, Ball W C. Extended experience in the long-term corticosteroid treatment of pulmonary sarcoidosis. Ann NY Acad Sci. 1976; 278 722-731
113 Odlum C M, FitzGerald M X. Evidence that steroids alter the natural history of previously untreated progressive pulmonary sarcoidosis. Sarcoidosis. 1986; 3 40-46
114 Bradvik I, Wollmer P, Blom-Bulow B, Albrechtsson U, Jonson B. Lung mechanics and gas exchange in steroid treated pulmonary sarcoidosis: a seveNYear follow-up. Sarcoidosis. 1991; 8 105-114
115 Zaki M H, Lyons H, Leilop L, Huang C. Corticosteroid therapy in sarcoidosis: a five-year, controlled follow-up study. NY State J Med. 1987; 87 496-499
116 Goldstein D S, Williams M H. Rate of improvement of pulmonary function in sarcoidosis during treatment with corticosteroids. Thorax. 1986; 41 473-474
117 Muller-Quernheim J, Pfeifer S, Strausz J, Ferlinz R. Correlation of clinical and immunologic parameters of the inflammatory activity of pulmonary sarcoidosis. Am Rev Respir Dis. 1991; 144 1322-1329
118 Siltzbach L E. The Kveim test in sarcoidosis: a study of 750 patients. JAMA. 1961; 178 476-482
119 Agostini C, Trentin L, Zambello R et al.. CD8 alveolitis in sarcoidosis: incidence, phenotypic characteristics, and clinical features. Am J Med. 1993; 95 466-472
120 Semenzato G, Bortoli M, Brunetti E, Agostini C. Immunology and pathophysiology. In: European Respiratory Monography on Sarcoidosis. 2006; 10 (monograph 32) 49-63
121 Robinson B W, McLemore T L, Crystal R G. Gamma interferon is spontaneously released by alveolar macrophages and lung T lymphocytes in patients with pulmonary sarcoidosis. J Clin Invest. 1985; 75 1488-1495
122 Pinkston P, Bitterman P B, Crystal R G. Spontaneous release of interleukin-2 by lung T lymphocytes in active pulmonary sarcoidosis. N Engl J Med. 1983; 308 793-800
123 Moller D R, Forman J D, Liu M C et al.. Enhanced expression of IL-12 associated with Th1 cytokine profiles in active pulmonary sarcoidosis. J Immunol. 1996; 156 4952-4960
124 Dinarello C A. IL-18: a TH1-inducing, proinflammatory cytokine and new member of the IL-1 family. J Allergy Clin Immunol. 1999; 103(1 Pt 1) 11-24
125 Shigehara K, Shijubo N, Ohmichi M et al.. Increased levels of interleukin-18 in patients with pulmonary sarcoidosis. Am J Respir Crit Care Med. 2000; 162 1979-1982
126 Baughman R P, Strohofer S A, Buchsbaum J, Lower E E. Release of tumor necrosis factor by alveolar macrophages of patients with sarcoidosis. J Lab Clin Med. 1990; 115 36-42
127 Steffen M, Petersen J, Oldigs M et al.. Increased secretion of tumor necrosis factor-alpha, interleukin-1-beta, and interleukin-6 by alveolar macrophages from patients with sarcoidosis. J Allergy Clin Immunol. 1993; 91 939-949
128 Agostini C, Trentin L, Facco M et al.. Role of IL-15, IL-2, and their receptors in the development of T cell alveolitis in pulmonary sarcoidosis. J Immunol. 1996; 157 910-918
129 Petrek M, Pantelidis P, Southcott A M et al.. The source and role of RANTES in interstitial lung disease. Eur Respir J. 1997; 10 1207-1216
130 Capelli A, Di Stefano A, Lusuardi M, Gnemmi I, Donner C F. Increased macrophage inflammatory protein-1alpha and macrophage inflammatory protein-1beta levels in bronchoalveolar lavage fluid of patients affected by different stages of pulmonary sarcoidosis. Am J Respir Crit Care Med. 2002; 165 236-241
131 Kunkel S L, Lukacs N W, Strieter R M, Chensue S W. Th1 and Th2 responses regulate experimental lung granuloma development. Sarcoidosis Vasc Diffuse Lung Dis. 1996; 13 120-128
132 Ward K, O'Connor C, Odlum C, Fitzgerald M X. Prognostic value of bronchoalveolar lavage in sarcoidosis: the critical influence of disease presentation. Thorax. 1989; 44 6-12
133 Gibejova A, Mrazek F, Subrtova D et al.. Expression of macrophage inflammatory protein-3 beta/CCL19 in pulmonary sarcoidosis. Am J Respir Crit Care Med. 2003; 167 1695-1703
134 Petrek M, Kolek V, Szotkowska J, du Bois R M. CC and C chemokine expression in pulmonary sarcoidosis. Eur Respir J. 2002; 20 1206-1212
135 Agostini C, Cassatella M, Zambello R et al.. Involvement of the IP-10 chemokine in sarcoid granulomatous reactions. J Immunol. 1998; 161 6413-6420
136 Armstrong L, Foley N M, Millar A B. Inter-relationship between tumour necrosis factor-alpha (TNF-alpha) and TNF soluble receptors in pulmonary sarcoidosis. Thorax. 1999; 54 524-530
137 Hino T, Nakamura H, Shibata Y, Abe S, Kato S, Tomoike H. Elevated levels of type II soluble tumor necrosis factor receptors in the bronchoalveolar lavage fluids of patients with sarcoidosis. Lung. 1997; 175 187-193
138 Hauber H P, Gholami D, Meyer A, Pforte A. Increased interleukin-13 expression in patients with sarcoidosis. Thorax. 2003; 58 519-524
139 Minshall E M, Tsicopoulos A, Yasruel Z et al.. Cytokine mRNA gene expression in active and nonactive pulmonary sarcoidosis. Eur Respir J. 1997; 10 2034-2039
140 Bingisser R, Speich R, Zollinger A, Russi E, Frei K. Interleukin-10 secretion by alveolar macrophages and monocytes in sarcoidosis. Respiration. 2000; 67 280-286
141 Grunewald J, Berlin M, Olerup O, Eklund A. Lung T-helper cells expressing T-cell receptor AV2S3 associate with clinical features of pulmonary sarcoidosis. Am J Respir Crit Care Med. 2000; 161(3 Pt 1) 814-818
142 Spagnolo P, Renzoni E A, Wells A U et al.. C-C chemokine receptor 2 and sarcoidosis: association with Löfgren's syndrome. Am J Respir Crit Care Med. 2003; 168 1162-1166
143 Berlin M, Fogdell-Hahn A, Olerup O, Eklund A, Grunewald J. HLA-DR predicts the prognosis in Scandinavian patients with pulmonary sarcoidosis. Am J Respir Crit Care Med. 1997; 156 1601-1605
144 Sato H, Grutters J C, Pantelidis P et al.. HLA-DQB1*0201: a marker for good prognosis in British and Dutch patients with sarcoidosis. Am J Respir Cell Mol Biol. 2002; 27 406-412
145 Costabel U, Guzman J, Albera A, Baughman R P. Bronchoalveolar lavage in sarcoidosis. In: Baughman RP Sarcoidosis. New York; Taylor and Francis Group 2006 210: 399-414
146 Welker L, Jorres R A, Costabel U, Magnussen H. Predictive value of BAL cell differentials in the diagnosis of interstitial lung diseases. Eur Respir J. 2004; 24 1000-1006
147 Drent M, van Velzen-Blad H, Diamant M, Hoogsteden H C, van den Bosch J M. Relationship between presentation of sarcoidosis and T lymphocyte profile: a study in bronchoalveolar lavage fluid. Chest. 1993; 104 795-800
148 Drent M, Mulder P G, Wagenaar S S, Hoogsteden H C, van Velzen-Blad H, van den Bosch J M. Differences in BAL fluid variables in interstitial lung diseases evaluated by discriminant analysis. Eur Respir J. 1993; 6 803-810
149 Bjermer L, Back O, Roos G, Thunell M. Mast cells and lysozyme positive macrophages in bronchoalveolar lavage from patients with sarcoidosis: valuable prognostic and activity marking parameters of disease?. Acta Med Scand. 1986; 220 161-166
150 Drent M, Jacobs J A, de Vries J, Lamers R J, Liem I H, Wouters E F. Does the cellular bronchoalveolar lavage fluid profile reflect the severity of sarcoidosis?. Eur Respir J. 1999; 13 1338-1344
151 Ziegenhagen M W, Rothe M E, Schlaak M, Muller-Quernheim J. Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis. Eur Respir J. 2003; 21 407-413
152 Laviolette M, La Forge J, Tennina S, Boulet L P. Prognostic value of bronchoalveolar lavage lymphocyte count in recently diagnosed pulmonary sarcoidosis. Chest. 1991; 100 380-384
153 Verstraeten A, Demedts M, Verwilghen J et al.. Predictive value of bronchoalveolar lavage in pulmonary sarcoidosis. Chest. 1990; 98 560-567
154 Valeyre D, Saumon G, Georges R et al.. The relationship between disease duration and noninvasive pulmonary explorations in sarcoidosis with erythema nodosum. Am Rev Respir Dis. 1984; 129 938-942
155 Mana J. Nuclear imaging: 67Gallium, 201thallium, 18F-labeled fluoro-2-deoxy-D-glucose positron emission tomography. Clin Chest Med. 1997; 18 799-811
156 Schuster D M, Alazraki N. Gallium and other agents in diseases of the lung. Semin Nucl Med. 2002; 32 193-211
157 Kwekkeboom D J, Krenning E P, Kho G S, Breeman W A, Van Hagen P M. Somatostatin receptor imaging in patients with sarcoidosis. Eur J Nucl Med. 1998; 25 1284-1292
158 Lebtahi R, Crestani B, Belmatoug N et al.. Somatostatin receptor scintigraphy and gallium scintigraphy in patients with sarcoidosis. J Nucl Med. 2001; 42 21-26
159 Shorr A F, Helman D L, Lettieri C J, Montilla J L, Bridwell R S. Depreotide scanning in sarcoidosis: a pilot study. Chest. 2004; 126 1337-1343
160 El-Haddad G, Zhuang H, Gupta N, Alavi A. Evolving role of positron emission tomography in the management of patients with inflammatory and other benign disorders. Semin Nucl Med. 2004; 34 313-329
161 Alavi A, Gupta N, Alberini J L et al.. Positron emission tomography imaging in nonmalignant thoracic disorders. Semin Nucl Med. 2002; 32 293-321
162 Halter G, Buck A K, Schirrmeister H et al.. [18F] 3-deoxy-3′-fluorothymidine positron emission tomography: alternative or diagnostic adjunct to 2-[18f]-fluoro-2-deoxy-D-glucose positron emission tomography in the workup of suspicious central focal lesions?. J Thorac Cardiovasc Surg. 2004; 127 1093-1099
163 Mana J, Vankroonenburgh M. Nuclear imaging techniques in sarcoidosis. Eur Respir Monograph on Sarcoidosis. 2005; 10(monograph 32) 284-300
164 Mediwake R, Wells A, Desai D. Radiological imaging in sarcoidosis. In: Baughman RP Sarcoidosis. New York; Taylor and Francis Group 2006 210: 365-398
165 Lewis P J, Salama A. Uptake of fluorine-18-fluorodeoxyglucose in sarcoidosis. J Nucl Med. 1994; 35 1647-1649
166 Brudin L H, Valind S O, Rhodes C G et al.. Fluorine-18 deoxyglucose uptake in sarcoidosis measured with positron emission tomography. Eur J Nucl Med. 1994; 21 297-305
167 Aberg C, Ponzo F, Raphael B, Amorosi E, Moran V, Kramer E. FDG positron emission tomography of bone involvement in sarcoidosis. AJR Am J Roentgenol. 2004; 182 975-977
168 Takeda N, Yokoyama I, Hiroi Y et al.. Positron emission tomography predicted recovery of complete A-V nodal dysfunction in a patient with cardiac sarcoidosis. Circulation. 2002; 105 1144-1145
169 Dubey N, Miletich R S, Wasay M, Mechtler L L, Bakshi R. Role of fluorodeoxyglucose positron emission tomography in the diagnosis of neurosarcoidosis. J Neurol Sci. 2002; 205 77-81
170 Gilman M J, Wang K P. Transbronchial lung biopsy in sarcoidosis: an approach to determine the optimal number of biopsies. Am Rev Respir Dis. 1980; 122 721-724
171 Poe R H, Israel R H, Utell M J, Hall W J. Probability of a positive transbronchial lung biopsy result in sarcoidosis. Arch Intern Med. 1979; 139 761-763
172 Wang K P, Fuenning C, Johns C J, Terry P B. Flexible transbronchial needle aspiration for the diagnosis of sarcoidosis. Ann Otol Rhinol Laryngol. 1989; 98(4 Pt 1) 298-300
173 Leonard C, Tormey V, Lennon A, Burke C M. Utility of Wang transbronchial needle biopsy in sarcoidosis. Ir J Med Sci. 1997; 166 41-43
174 Cetinkaya E, Yildiz P, Kadakal F et al.. Transbronchial needle aspiration in the diagnosis of intrathoracic lymphadenopathy. Respiration. 2002; 69 335-338
175 Sharafkhaneh A, Baaklini W, Gorin A B, Green L. Yield of transbronchial needle aspiration in diagnosis of mediastinal lesions. Chest. 2003; 124 2131-2135
176 Trisolini R, Agli L L, Cancellieri A et al.. The value of flexible transbronchial needle aspiration in the diagnosis of stage I sarcoidosis. Chest. 2003; 124 2126-2130
177 Morales C F, Patefield A J, Strollo Jr P J, Schenk D A. Flexible transbronchial needle aspiration in the diagnosis of sarcoidosis. Chest. 1994; 106 709-711
178 Trisolini R, Lazzari Agli L, Cancellieri A et al.. Transbronchial needle aspiration improves the diagnostic yield of bronchoscopy in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2004; 21 147-151
179 Khoo K L, Ho K Y, Nilsson B, Lim T K. EUS-guided FNA immediately after unrevealing transbronchial needle aspiration in the evaluation of mediastinal lymphadenopathy: a prospective study. Gastrointest Endosc. 2006; 63 215-220
180 Tambouret R, Geisinger K R, Powers C N et al.. The clinical application and cost analysis of fine-needle aspiration biopsy in the diagnosis of mass lesions in sarcoidosis. Chest. 2000; 117 1004-1011
181 Prakash U B, Offord K P, Stubbs S E. Bronchoscopy in North America: the ACCP survey. Chest. 1991; 100 1668-1675
182 Zwischenberger J B, Savage C, Alpard S K, Anderson C M, Marroquin S, Goodacre B W. Mediastinal transthoracic needle and core lymph node biopsy: should it replace mediastinoscopy?. Chest. 2002; 121 1165-1170
183 Pedersen B H, Vilmann P, Folke K et al.. Endoscopic ultrasonography and real-time guided fine-needle aspiration biopsy of solid lesions of the mediastinum suspected of malignancy. Chest. 1996; 110 539-544
184 Vilmann P, Krasnik M, Larsen S S, Jacobsen G K, Clementsen P. Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions. Endoscopy. 2005; 37 833-839
185 Larsen S S, Krasnik M, Vilmann P et al.. Endoscopic ultrasound guided biopsy of mediastinal lesions has a major impact on patient management. Thorax. 2002; 57 98-103
186 Wiersema M J, Vazquez-Sequeiros E, Wiersema L M. Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy. Radiology. 2001; 219 252-257
187 Hammoud Z T, Anderson R C, Meyers B F et al.. The current role of mediastinoscopy in the evaluation of thoracic disease. J Thorac Cardiovasc Surg. 1999; 118 894-899
188 Kirschner P A. Cervical mediastinoscopy. Chest Surg Clin N Am. 1996; 6 1-20
189 Venissac N, Alifano M, Mouroux J. Video-assisted mediastinoscopy: experience from 240 consecutive cases. Ann Thorac Surg. 2003; 76 208-212
190 Rosen Y, Moon S, Huang C T, Gourin A, Lyons H A. Granulomatous pulmonary angiitis in sarcoidosis. Arch Pathol Lab Med. 1977; 101 170-174
191 Smith L J, Lawrence J B, Katzenstein A A. Vascular sarcoidosis: a rare cause of pulmonary hypertension. Am J Med Sci. 1983; 285 38-44
192 Barst R J, Ratner S J. Sarcoidosis and reactive pulmonary hypertension. Arch Intern Med. 1985; 145 2112-2114
193 Gluskowski J, Hawrylkiewicz I, Zych D, Zielinski J. Effects of corticosteroid treatment on pulmonary haemodynamics in patients with sarcoidosis. Eur Respir J. 1990; 3 403-407
194 Battesti J P, Georges R, Basset F, Saumon G. Chronic cor pulmonale in pulmonary sarcoidosis. Thorax. 1978; 33 76-84
195 Emirgil C, Sobol B J, Herbert W H, Trout K. The lesser circulation in pulmonary fibrosis secondary to sarcoidosis and its relationship to respiratory function. Chest. 1971; 60 371-378
196 Gluskowski J, Hawrylkiewicz I, Zych D, Wojtczak A, Zielinski J. Pulmonary haemodynamics at rest and during exercise in patients with sarcoidosis. Respiration. 1984; 46 26-32
197 Arcasoy S M, Christie J D, Pochettino A et al.. Characteristics and outcomes of patients with sarcoidosis listed for lung transplantation. Chest. 2001; 120 873-880
198 Shorr A F, Davies D B, Nathan S D. Outcomes for patients with sarcoidosis awaiting lung transplantation. Chest. 2002; 122 233-238
199 Shorr A F, Davies D B, Nathan S D. Predicting mortality in patients with sarcoidosis awaiting lung transplantation. Chest. 2003; 124 922-928
200 Shorr A F, Helman D L, Davies D B, Nathan S D. Pulmonary hypertension in advanced sarcoidosis: epidemiology and clinical characteristics. Eur Respir J. 2005; 25 783-788
201 Preston I R, Klinger J R, Landzberg M J, Houtchens J, Nelson D, Hill N S. Vasoresponsiveness of sarcoidosis-associated pulmonary hypertension. Chest. 2001; 120 866-872
202 Nunes H, Humbert M, Capron F et al.. Pulmonary hypertension associated with sarcoidosis: mechanisms, haemodynamics and prognosis. Thorax. 2006; 61 68-74
203 Damuth T E, Bower J S, Cho K, Dantzker D R. Major pulmonary artery stenosis causing pulmonary hypertension in sarcoidosis. Chest. 1980; 78 888-891
204 Tan R T, Kuzo R, Goodman L R, Siegel R, Haasler G B, Presberg K W. Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Medical College of Wisconsin Lung Transplant Group. Chest. 1998; 113 1250-1256
205 Ng C S, Wells A U, Padley S PA. CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter. J Thorac Imaging. 1999; 14 270-278
206 Humbert M, Sitbon O, Simonneau G. Treatment of pulmonary arterial hypertension. N Engl J Med. 2004; 351 1425-1436
207 Jones K, Higenbottam T, Wallwork J. Pulmonary vasodilation with prostacyclin in primary and secondary pulmonary hypertension. Chest. 1989; 96 784-789
208 Hamper U M, Fishman E K, Khouri N F, Johns C J, Wang K P, Siegelman S S. Typical and atypical CT manifestations of pulmonary sarcoidosis. J Comput Assist Tomogr. 1986; 10 928-936
209 Hietala S O, Stinnett R G, Faunce III H F, Sharpe Jr A R, Scoggins W G, Smith R H. Pulmonary artery narrowing in sarcoidosis. JAMA. 1977; 237 572-573
210 Westcott J L, DeGraff Jr A C. Sarcoidosis, hilar adenopathy, and pulmonary artery narrowing. Radiology. 1973; 108 585-586
211 Hoffstein V, Ranganathan N, Mullen J B. Sarcoidosis simulating pulmonary veno-occlusive disease. Am Rev Respir Dis. 1986; 134 809-811
212 Schachter E N, Smith G J, Cohen G S, Lee S H, Laser A, Gee J B. Pulmonary granulomas in a patient with pulmonary veno-occlusive disease. Chest. 1975; 67 487-489
213 Javaheri S, Hales C A. Sarcoidosis: a cause of innominate vein obstruction and massive pleural effusion. Lung. 1980; 157 81-85
214 Gordonson J, Trachtenberg S, Sargent E N. Superior vena cava obstruction due to sarcoidosis. Chest. 1973; 63 292-293
215 Brandstetter R D, Hansen D E, Jarowski C I, King T, Barletta A. Superior vena cava syndrome as the initial clinical manifestation of sarcoidosis. Heart Lung. 1981; 10 101-104
216 Radke J R, Kaplan H, Conway W A. The significance of superior vena cava syndrome developing in a patient with sarcoidosis. Radiology. 1980; 134 311-312
217 Kinney E L, Murthy R, Ascunce G, Guntapalli K K, Zelis R. Sarcoidosis: rare cause of superior vena caval obstruction. Pa Med. 1980; 83 31
218 Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 11-1984. Long-standing sarcoidosis with the recent onset of the superior-vena-cava syndrome. N Engl J Med. 1984; 310 708-716
219 Narayan D, Brown L, Thayer J O. Surgical management of superior vena caval syndrome in sarcoidosis. Ann Thorac Surg. 1998; 66 946-948
220 Fincher R M, Sherman E B. Superior vena caval obstruction due to sarcoidosis. South Med J. 1986; 79 1306-1308
221 Liebow A A, The J. Burns Amberson lecture: pulmonary angiitis and granulomatosis. Am Rev Respir Dis. 1973; 108 1-18
222 Churg A. Pulmonary angiitis and granulomatosis revisited. Hum Pathol. 1983; 14 868-883
223 Chittock D R, Joseph M G, Paterson N A, McFadden R G. Necrotizing sarcoid granulomatosis with pleural involvement: clinical and radiographic features. Chest. 1994; 106 672-676
224 Niimi H, Hartman T E, Muller N L. Necrotizing sarcoid granulomatosis: computed tomography and pathologic findings. J Comput Assist Tomogr. 1995; 19 920-923
225 Koss M N, Hochholzer L, Feigin D S, Garancis J C, Ward P A. Necrotizing sarcoid-like granulomatosis: clinical, pathologic, and immunopathologic findings. Hum Pathol. 1980; 11(Suppl 5) 510-519
226 Churg A, Carrington C B, Gupta R. Necrotizing sarcoid granulomatosis. Chest. 1979; 76 406-413
227 Quaden C, Tillie-Leblond I, Delobbe A et al.. Necrotising sarcoid granulomatosis: clinical, functional, endoscopical and radiographical evaluations. Eur Respir J. 2005; 26 778-785
228 Sadoun D, Kambouchner M, Tazi A et al.. Necrotizing sarcoid granulomatosis: apropos of 4 cases [in French]. Ann Med Interne (Paris). 1994; 145 230-233
229 Saldana M. Necrotizing sarcoid granulomatosis: clinicopathologic observations in 24 patients. Lab Invest. 1978; 38 364
230 Beach R C, Corrin B, Scopes J W, Graham E. Necrotizing sarcoid granulomatosis with neurologic lesions in a child. J Pediatr. 1980; 97 950-953
231 Singh N, Cole S, Krause P J, Conway M, Garcia L. Necrotizing sarcoid granulomatosis with extrapulmonary involvement: clinical, pathologic, ultrastructural, and immunologic features. Am Rev Respir Dis. 1981; 124 189-192
232 Spiteri M A, Gledhill A, Campbell D, Clarke S W. Necrotizing sarcoid granulomatosis. Br J Dis Chest. 1987; 81 70-75
233 Gibbs A R, Williams W J, Kelland D. Necrotising sarcoidal granulomatosis: a problem of identity: a study of seven cases. Sarcoidosis. 1987; 4 94-100
234 Dykhuizen R S, Smith C C, Kennedy M M, McLay K A, Cockburn J S, Kerr K M. Necrotizing sarcoid granulomatosis with extrapulmonary involvement. Eur Respir J. 1997; 10 245-247
235 Onal E, Lopata M, Lourenco R V. Nodular pulmonary sarcoidosis: clinical, roentgenographic, and physiologic course in five patients. Chest. 1977; 72 296-300
236 Romer F K. Sarcoidosis with large nodular lesions simulating pulmonary metastases: an analysis of 126 cases of intrathoracic sarcoidosis. Scand J Respir Dis. 1977; 58 11-16
237 Rose R M, Lee R G, Costello P. Solitary nodular sarcoidosis. Clin Radiol. 1985; 36 589-592
238 Tellis C J, Putnam J S. Cavitation in large multinodular pulmonary disease a rare manifestation of sarcoidosis. Chest. 1977; 71 792-793
239 Olsson T, Bjornstad-Pettersen H, Stjernberg N L. Bronchostenosis due to sarcoidosis: a cause of atelectasis and airway obstruction simulating pulmonary neoplasm and chronic obstructive pulmonary disease. Chest. 1979; 75 663-666
240 Mendelson D S, Norton K, Cohen B A, Brown L K, Rabinowitz J G. Bronchial compression: an unusual manifestation of sarcoidosis. J Comput Assist Tomogr. 1983; 7 892-894
241 Armstrong J R, Radke J R, Kvale P A, Eichenhorn M S, Popovich Jr J. Endoscopic findings in sarcoidosis: characteristics and correlations with radiographic staging and bronchial mucosal biopsy yield. Ann Otol Rhinol Laryngol. 1981; 90(4 Pt 1) 339-343
242 Munt P W. Middle lobe atelectasis in sarcoidois: report of a case with prompt resolution concomitant with corticosteroid administration. Am Rev Respir Dis. 1973; 108 357-360
243 Rockoff S D, Rohatgi P K. Unusual manifestations of thoracic sarcoidosis. AJR Am J Roentgenol. 1985; 144 513-528
244 Aye M, Campbell A P, Greenstone M A. An unusual case of lobar collapse. Chest. 2002; 122 1465-1466
245 Naidich D P, Lee J J, Garay S M, McCauley D I, Aranda C P, Boyd A D. Comparison of CT and fiberoptic bronchoscopy in the evaluation of bronchial disease. AJR Am J Roentgenol. 1987; 148 1-7
246 Fouty B W, Pomeranz M, Thigpen T P, Martin R J. Dilatation of bronchial stenoses due to sarcoidosis using a flexible fiberoptic bronchoscope. Chest. 1994; 106 677-680
247 Wollschlager C, Khan F. Aspergillomas complicating sarcoidosis: a prospective study in 100 patients. Chest. 1984; 86 585-588
248 Chaudhary B A, McAlexander D, el Gammal T, Speir W A. Multiple mycetomas due to Pseudallescheria boydii. . South Med J. 1987; 80 653-654
249 Libshitz H I, Atkinson G W, Israel H L. Pleural thickening as a manifestation of aspergillus superinfection. Am J Roentgenol Radium Ther Nucl Med. 1974; 120 883-886
250 Fujimura M, Ishiura Y, Kasahara K et al.. Necrotizing bronchial aspergillosis as a cause of hemoptysis in sarcoidosis. Am J Med Sci. 1998; 315 56-58
251 Shapiro M J, Albelda S M, Mayock R L, McLean G K. Severe hemoptysis associated with pulmonary aspergilloma: percutaneous intracavitary treatment. Chest. 1988; 94 1225-1231
252 Rumbak M, Kohler G, Eastrige C, Winer-Muram H, Gavant M. Topical treatment of life threatening haemoptysis from aspergillomas. Thorax. 1996; 51 253-255
253 Nicholls A J, Friend J A, Legge J S. Sarcoid pleural effusion: three cases and review of the literature. Thorax. 1980; 35 277-281
254 Sharma O P, Gordonson J. Pleural effusion in sarcoidosis: a report of six cases. Thorax. 1975; 30 95-101
255 Soskel N, Sharma O P. Pleural involvement in sarcoidosis: case presentation and detailed review of the literature. Semin Respir Med. 1992; 13 492-514
256 Warshawsky M E, Shanies H M, Rozo A. Sarcoidosis involving the thyroid and pleura. Sarcoidosis Vasc Diffuse Lung Dis. 1997; 14 165-168
257 Huggins J T, Doelken P, Sahn S A, King L, Judson M A. Pleural effusions in a series of 181 outpatients with sarcoidosis. Chest. 2006; 129 1599-1604
258 Wilen S B, Rabinowitz J G, Ulreich S, Lyons H A. Pleural involvement in sarcoidosis. Am J Med. 1974; 57 200-209
259 Soskel N T, Sharma O P. Pleural involvement in sarcoidosis. Curr Opin Pulm Med. 2000; 6 455-468
260 Ohmichi M, Hiraga Y, Hirasawa M. Pulmonary involvements of sarcoidosis [in Japanese]. Nihon Kyobu Shikkan Gakkai Zasshi. 1990; 28 48-55
261 Szwarcberg J B, Glajchen N, Teirstein A S. Pleural involvement in chronic sarcoidosis detected by thoracic CT scanning. Sarcoidosis Vasc Diffuse Lung Dis. 2005; 22 58-62
262 Beekman J F, Zimmet S M, Chun B K, Miranda A A, Katz S. Spectrum of pleural involvement in sarcoidosis. Arch Intern Med. 1976; 136 323-330
263 Ellis K, Renthal G. Pulmonary sarcoidosis: roentgenographic observations on course of disease. AJR Am J Roentgenol. 1962; 88 1070-1083
264 Bergstrom C E, Eklund A. Sarcoidosis with pleural involvement mimicking a coin lesion. Sarcoidosis. 1990; 7 78-79
265 Loughney E, Higgins B G. Pleural sarcoidosis: a rare presentation. Thorax. 1997; 52 200-201
266 Miller B H, Rosado-de-Christenson M L, McAdams H P, Fishback N F. Thoracic sarcoidosis: radiologic-pathologic correlation. Radiographics. 1995; 15 421-437
267 Remy-Jardin M, Beuscart R, Sault M C, Marquette C H, Remy J. Subpleural micronodules in diffuse infiltrative lung diseases: evaluation with thin-section CT scans. Radiology. 1990; 177 133-139
268 Kostina Z I, Ivanovskii V B, Voloshko I V, Kol'nikova O V, Khorovskaia L A. Diagnosis and treatment of pleural lesions in sarcoidosis of the respiratory organs [in Russian]. Probl Tuberk. 1992; 7-8 21-23
269 Flammang d'Ortho M P, Cadranel J, Milleron B J, Akoun G M. Pleural, alveolar and blood T-lymphocyte subsets in pleuropulmonary sarcoidosis. Chest. 1990; 98 782-783
270 Groman G S, Castele R J, Altose M D, Scillian J, Kleinhenz M E, Ehlers R. Lymphocyte subpopulations in sarcoid pleural effusion. Ann Intern Med. 1984; 100 75-77
271 van der Werf T S, Vennik P H. Rare presentation or lead time bias in pleural sarcoidosis?. Thorax. 1997; 52 752
272 Tudela P, Haro M, Marti S, Roig J. Eosinophilic pleuritis as the presenting form of sarcoidosis [in Spanish]. Med Clin (Barc). 1992; 99 558
273 Claiborne R A, Kerby G R. Pleural sarcoidosis with massive effusion and lung entrapment. Kans Med. 1990; 91 103-105
274 Berte S J, Pfotenhauer M A. Massive pleural effusion in sarcoidosis. Am Rev Respir Dis. 1962; 86 261-264
275 Krawczyk I, Sedlaczek A M. A case of sarcoidosis with massive pleural and pericardial effusion [in Polish]. Pneumonol Alergol Pol. 1997; 65 81-85
276 Schmidt R J, Bender F H, Chang W W, Teba L. Sarcoidosis after renal transplantation. Transplantation. 1999; 68 1420-1423
277 Balasubramanian P, Mathew J, Cherian R, Abraham O C. Bilateral massive pleural effusion: a rare presentation of sarcoidosis. J Postgrad Med. 2005; 51 335-336
278 Heidecker J T, Judson M A. Pleural effusion caused by trapped lung. South Med J. 2003; 96 510-511
279 Froudarakis M E, Bouros D, Voloudaki A et al.. Pneumothorax as a first manifestation of sarcoidosis. Chest. 1997; 112 278-280
280 Akelsson I G, Eklund A, Skold C M, Tornling G. Bilateral spontaneous pneumothorax and sarcoidosis. Sarcoidosis. 1990; 7 136-138
281 Ross R J, Empey D W. Bilateral spontaneous pneumothorax in sarcoidosis. Postgrad Med J. 1983; 59 106-107
282 Gomm S A. An unusual presentation of sarcoidosis: spontaneous haemopneumothorax. Postgrad Med J. 1984; 60 621-623
283 Aberg H, Bah M, Waters A W. Sarcoidosis: complicated by chylothorax. Minn Med. 1966; 49 1065-1070
284 Cappell M S, Friedman D, Mikhail N. Chyloperitoneum associated with chronic severe sarcoidosis. Am J Gastroenterol. 1993; 88 99-101
285 Jarman P R, Whyte M K, Sabroe I, Hughes J M. Sarcoidosis presenting with chylothorax. Thorax. 1995; 50 1324-1325
286 Lengyel R J, Shanley D J. Recurrent chylothorax associated with sarcoidosis. Hawaii Med J. 1995; 54 817-818
287 Parker J M, Torrington K G, Phillips Y Y. Sarcoidosis complicated by chylothorax. South Med J. 1994; 87 860-862
288 Haramati L B, Lee G, Singh A, Molina P L, White C S. Newly diagnosed pulmonary sarcoidosis in HIV-infected patients. Radiology. 2001; 218 242-246
289 Newman T G, Minkowitz S, Hanna A, Sikand R, Fuleihan F. Coexistent sarcoidosis and HIV infection: a comparison of bronchoalveolar and peripheral blood lymphocytes. Chest. 1992; 102 1899-1901
290 Gomez V, Smith P R, Burack J, Daley R, Rosa U. Sarcoidosis after antiretroviral therapy in a patient with acquired immunodeficiency syndrome. Clin Infect Dis. 2000; 31 1278-1280
291 Foulon G, Wislez M, Naccache J M et al.. Sarcoidosis in HIV-infected patients in the era of highly active antiretroviral therapy. Clin Infect Dis. 2004; 38 418-425
292 Naccache J M, Antoine M, Wislez M et al.. Sarcoid-like pulmonary disorder in human immunodeficiency virus-infected patients receiving antiretroviral therapy. Am J Respir Crit Care Med. 1999; 159 2009-2013
293 Blanche P, Gombert B, Rollot F, Salmon D, Sicard D. Sarcoidosis in a patient with acquired immunodeficiency syndrome treated with interleukin-2. Clin Infect Dis. 2000; 31 1493-1494
294 Mirmirani P, Maurer T A, Herndier B, McGrath M, Weinstein M D, Berger T G. Sarcoidosis in a patient with AIDS: a manifestation of immune restoration syndrome. J Am Acad Dermatol. 1999; 41(2 Pt 2) 285-286
295 Lenner R, Bregman Z, Teirstein A S, DePalo L. Recurrent pulmonary sarcoidosis in HIV-infected patients receiving highly active antiretroviral therapy. Chest. 2001; 119 978-981
296 Granieri J, Wisnieski J J, Graham R C, Smith H, Gogate P, Aucott J N. Sarcoid myopathy in a patient with human immunodeficiency virus infection. South Med J. 1995; 88 591-595
297 Morris D G, Jasmer R M, Huang L, Gotway M B, Nishimura S, King Jr T E. Sarcoidosis following HIV infection: evidence for CD4 + lymphocyte dependence. Chest. 2003; 124 929-935
298 Trevenzoli M, Cattelan A M, Marino F, Marchioro U, Cadrobbi P. Sarcoidosis and HIV infection: a case report and a review of the literature. Postgrad Med J. 2003; 79 535-538
299 Mayaud C M, Cadranel J. HIV in the lung: guilty or not guilty?. Thorax. 1993; 48 1191-1195
300 Levy Y, Capitant C, Houhou S et al.. Comparison of subcutaneous and intravenous interleukin-2 in asymptomatic HIV-1 infection: a randomised controlled trial. ANRS 048 study group. Lancet. 1999; 353 1923-1929
301 Charlier C, Nunes H, Trinchet J C et al.. Evolution of previous sarcoidosis under type 1 interferons given for severe associated disease. Eur Respir J. 2005; 25 570-573
302 Leclerc S, Myers R P, Moussalli J, Herson S, Poynard T, Benveniste O. Sarcoidosis and interferon therapy: report of five cases and review of the literature. Eur J Intern Med. 2003; 14 237-243
303 Goldberg H J, Fiedler D, Webb A, Jagirdar J, Hoyumpa A M, Peters J. Sarcoidosis after treatment with interferon-alpha: a case series and review of the literature. Respir Med. 2006; 210
304 Ramos-Casals M, Mana J, Nardi N et al.. Sarcoidosis in patients with chronic hepatitis C virus infection: analysis of 68 cases. Medicine (Baltimore). 2005; 84 69-80
305 Menon Y, Cucurull E, Reisin E, Espinoza L R. Interferon-alpha-associated sarcoidosis responsive to infliximab therapy. Am J Med Sci. 2004; 328 173-175
306 Ravenel J G, McAdams H P, Plankeel J F, Butnor K J, Sporn T A. Sarcoidosis induced by interferon therapy. AJR Am J Roentgenol. 2001; 177 199-201
307 Pietropaoli A, Modrak J, Utell M. Interferon-alpha therapy associated with the development of sarcoidosis. Chest. 1999; 116 569-572
308 Rubinowitz A N, Naidich D P, Alinsonorin C. Interferon-induced sarcoidosis. J Comput Assist Tomogr. 2003; 27 279-283
309 Husa P, Klusakova J, Jancikova J, Husova L, Horalek F. Sarcoidosis associated with interferon-alpha therapy for chronic hepatitis B. Eur J Intern Med. 2002; 13 129-131
310 Hurst E A, Mauro T. Sarcoidosis associated with pegylated interferon alfa and ribavirin treatment for chronic hepatitis C: a case report and review of the literature. Arch Dermatol. 2005; 141 865-868
311 Butnor K J. Pulmonary sarcoidosis induced by interferon-alpha therapy. Am J Surg Pathol. 2005; 29 976-979
312 Yavorkovsky L L, Carrum G, Bruce S, McCarthy Jr P L. Cutaneous sarcoidosis in a patient with Philadelphia-positive chronic myelogenous leukemia treated with interferon-alpha. Am J Hematol. 1998; 58 80-81
313 Schmuth M, Prior C, Illersperger B, Topar G, Fritsch P, Sepp N. Systemic sarcoidosis and cutaneous lymphoma: is the association fortuitous?. Br J Dermatol. 1999; 140 952-955
314 Hoffmann R M, Jung M C, Motz R et al.. Sarcoidosis associated with interferon-alpha therapy for chronic hepatitis C. J Hepatol. 1998; 28 1058-1063
315 Nawras A, Alsolaiman M M, Mehboob S, Bartholomew C, Maliakkal B. Systemic sarcoidosis presenting as a granulomatous tattoo reaction secondary to interferon-alpha treatment for chronic hepatitis C and review of the literature. Dig Dis Sci. 2002; 47 1627-1631
316 Baughman R P, Sharma O P, Lynch III J P. Sarcoidosis: is therapy effective?. Semin Respir Infect. 1998; 13 255-273
317 White E, Keena D, Zisman D, Lynch III J P. Corticosteroid therapy for sarcoidosis. In: Baughman RP Sarcoidosis. New York; Taylor and Francis Group 2006 210: 689-716
318 Pietinalho A, Tukiainen P, Haahtela T, Persson T, Selroos O. Early treatment of stage II sarcoidosis improves 5-year pulmonary function. Chest. 2002; 121 24-31
319 Spiteri M A, Newman S P, Clarke S W, Poulter L W. Inhaled corticosteroids can modulate the immunopathogenesis of pulmonary sarcoidosis. Eur Respir J. 1989; 2 218-224
320 Spiteri M A. Inhaled corticosteroids in pulmonary sarcoidosis. Postgrad Med J. 1991; 67 327-329
321 du Bois R M, Greenhalgh P M, Southcott A M, Johnson N M, Harris T A. Randomized trial of inhaled fluticasone propionate in chronic stable pulmonary sarcoidosis: a pilot study. Eur Respir J. 1999; 13 1345-1350
322 Zych D, Pawlicka L, Zielinski J. Inhaled budesonide vs prednisone in the maintenance treatment of pulmonary sarcoidosis. Sarcoidosis. 1993; 10 56-61
323 Milman N, Graudal N, Grode G, Munch E. No effect of high-dose inhaled steroids in pulmonary sarcoidosis: a double-blind, placebo-controlled study. J Intern Med. 1994; 236 285-290
324 Baughman R, Mihailovic-Vucinic V. Nonsteroidal therapy of sarcoidosis. In: Baughman RP Sarcoidosis. New York; Taylor and Francis Group 2006 210: 717-744
325 Baughman R P, Lower E E. A clinical approach to the use of methotrexate for sarcoidosis. Thorax. 1999; 54 742-746
326 Lower E E, Baughman R P. Prolonged use of methotrexate for sarcoidosis. Arch Intern Med. 1995; 155 846-851
327 Baughman R P, Lower E E. The effect of corticosteroid or methotrexate therapy on lung lymphocytes and macrophages in sarcoidosis. Am Rev Respir Dis. 1990; 142 1268-1271
328 Muller-Quernheim J, Kienast K, Held M, Pfeifer S, Costabel U. Treatment of chronic sarcoidosis with an azathioprine/prednisolone regimen. Eur Respir J. 1999; 14 1117-1122
329 Pacheco Y, Marechal C, Marechal F, Biot N, Perrin Fayolle M. Azathioprine treatment of chronic pulmonary sarcoidosis. Sarcoidosis. 1985; 2 107-113
330 Lewis S J, Ainslie G M, Bateman E D. Efficacy of azathioprine as second-line treatment in pulmonary sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 1999; 16 87-92
331 Majithia V, Sanders S, Harisdangkul V, Wilson J G. Successful treatment of sarcoidosis with leflunomide. Rheumatology (Oxford). 2003; 42 700-702
332 Baughman R P, Lower E E. Leflunomide for chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2004; 21 43-48
333 Demeter S L. Myocardial sarcoidosis unresponsive to steroids: treatment with cyclophosphamide. Chest. 1988; 94 202-203
334 Lower E E, Broderick J P, Brott T G, Baughman R P. Diagnosis and management of neurological sarcoidosis. Arch Intern Med. 1997; 157 1864-1868
335 Doty J D, Mazur J E, Judson M A. Treatment of corticosteroid-resistant neurosarcoidosis with a short-course cyclophosphamide regimen. Chest. 2003; 124 2023-2026
336 Kataria Y P. Chlorambucil in sarcoidosis. Chest. 1980; 78 36-43
337 Martinet Y, Pinkston P, Saltini C, Spurzem J, Muller-Quernheim J, Crystal R G. Evaluation of the in vitro and in vivo effects of cyclosporine on the lung T-lymphocyte alveolitis of active pulmonary sarcoidosis. Am Rev Respir Dis. 1988; 138 1242-1248
338 Baltzan M, Mehta S, Kirkham T H, Cosio M G. Randomized trial of prolonged chloroquine therapy in advanced pulmonary sarcoidosis. Am J Respir Crit Care Med. 1999; 160 192-197
339 O'Leary T J, Jones G, Yip A, Lohnes D, Cohanim M, Yendt E R. The effects of chloroquine on serum 1,25-dihydroxyvitamin D and calcium metabolism in sarcoidosis. N Engl J Med. 1986; 315 727-730
340 Zic J A, Horowitz D H, Arzubiaga C, King Jr L E. Treatment of cutaneous sarcoidosis with chloroquine: review of the literature. Arch Dermatol. 1991; 127 1034-1040
341 Tong Z, Dai H, Chen B, Abdoh Z, Guzman J, Costabel U. Inhibition of cytokine release from alveolar macrophages in pulmonary sarcoidosis by pentoxifylline: comparison with dexamethasone. Chest. 2003; 124 1526-1532
342 Zabel P, Entzian P, Dalhoff K, Schlaak M. Pentoxifylline in treatment of sarcoidosis. Am J Respir Crit Care Med. 1997; 155 1665-1669
343 Baughman R P, Judson M A, Teirstein A S, Moller D R, Lower E E. Thalidomide for chronic sarcoidosis. Chest. 2002; 122 227-232
344 Carlesimo M, Giustini S, Rossi A, Bonaccorsi P, Calvieri S. Treatment of cutaneous and pulmonary sarcoidosis with thalidomide. J Am Acad Dermatol. 1995; 32(5 Pt 2) 866-869
345 Oliver S J, Kikuchi T, Krueger J G, Kaplan G. Thalidomide induces granuloma differentiation in sarcoid skin lesions associated with disease improvement. Clin Immunol. 2002; 102 225-236
346 Utz J P, Limper A H, Kalra S et al.. Etanercept for the treatment of stage II and III progressive pulmonary sarcoidosis. Chest. 2003; 124 177-185
347 Baughman R P, Lower E E. Infliximab for refractory sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2001; 18 70-74
348 Pettersen J A, Zochodne D W, Bell R B, Martin L, Hill M D. Refractory neurosarcoidosis responding to infliximab. Neurology. 2002; 59 1660-1661
349 Yee A M, Pochapin M B. Treatment of complicated sarcoidosis with infliximab anti-tumor necrosis factor-alpha therapy. Ann Intern Med. 2001; 135 27-31
350 Lynch III J P, McCune W J. Immunosuppressive and cytotoxic pharmacotherapy for pulmonary disorders. Am J Respir Crit Care Med. 1997; 155 395-420
351 Nathan S, Saggar R, Lynch J. Lung transplantation for interstitial lung disorders. In: Lynch JP III, Ross DJ Lung and Heart-Lung Transplantation. New York; Taylor and Francis Group 2006 217: 165-204

Joseph P Lynch IIIM.D.

The David Geffen School of Medicine at UCLA, Division of Pulmonary, Critical Care Medicine, and Hospitalists

10833 Le Conte Ave., Rm. 37-131 CHS, Los Angeles, CA 90095

Email: jplynch@mednet.ucla.edu