Ms. Zhu recently underwent a routine lung CT examination, suggesting that the hilar and mediastinal lymph nodes are enlarged, and it was also found that the lymph nodes in the neck are swollen, and there are lymph nodes of different sizes in the abdominal cavity, which is worried that it is a malignant tumor and the mood has fallen to the bottom. A right cervical lymph node biopsy was performed at the end of December 2021, and pathology reports suggest a predisposition to sarcoidosis.
Zeng Xiangbo, director of the Department of Respiratory and Critical Care Medicine of the Second People's Hospital of Hunan Province (Hunan Brain Hospital), introduced that sarcoidosis is a multi-system, multi-organ granulomatous disease of unknown etiology, which often invades the lungs, bilateral hilar lymph nodes, eyes, skin and other organs, of which pulmonary sarcoidosis accounts for 80% to 90%. The incidence is higher in Europe and the United States, but it is relatively rare in Asia, mostly in the 20-40 years old, and there are slightly more women than men.
Director Zeng Xiangbo made a round
"The clinical manifestations of sarcoidosis vary according to the urgency of its onset and the number of organs involved," said Zeng Xiangbo, who may have no obvious signs and symptoms in the early stages of the disease. Sometimes there is cough, coughing up a small amount of sputum, occasionally a small amount of hemoptysis, may have fatigue, fever, night sweats, loss of appetite, weight loss and so on. Chest tightness, shortness of breath, and even cyanosis may occur when the lesions are extensive. May be exacerbated by co-infection, emphysema, bronchiectasis, and pulmonary heart disease.
Sarcoidosis can affect one organ or invade multiple organs at the same time. Symmetrical enlargement of bilateral hilar and mediastinal lymph nodes on chest x-ray is often the first finding of sarcoidosis, with more than 90% of patients with changes in chest x-ray. Pathological diagnosis of living tissues such as superficially enlarged lymph nodes, enlarged mediastinal lymph nodes, nodules of the endobronchial lining, lymph nodes of the anterior oblique muscle fat pad, liver puncture, or lung biopsy can be diagnosed as sarcoidosis.
"Sarcoidosis is not a terminal disease, most sarcoidosis has the possibility of self-remission, stable, asymptomatic patients do not need special treatment," Zeng Xiangbo explained, "patients with obvious symptoms of stage II., III. patients, patients with rapid progression and extrathoracic sarcoidosis can be treated with glucocorticoids." Prednisone is often used orally for a year or longer. Long-term use of glucocorticoids requires close observation of the adverse reactions of hormones. Most patients have a better prognosis, with acute onset having a better prognosis after treatment or self-remission, while chronic progressivity, invasion of multiple organs, functional impairment, extensive pulmonary fibrosis or acute infection are poorer."
"Many outpatients confuse lung nodules with lung sarcoidosis because of physical examination, but in fact, they are not", Zeng Xiangbo said, "Lung nodules generally refer to focal, rounded, densely increased lung shadows in the lungs that are less than 3 cm, and benign lesions include inflammatory pseudomas, tuberculous bulbs, aspergigmosum, fibroids, granulomatous diseases, etc.; malignant lesions include lung cancer and metastatic tumors." Pulmonary sarcoidosis is a relatively rare disease of pulmonary granulomatous, which can manifest as a lung nodule and more commonly as hilar and mediastinal lymphadenopathy. "Whether it is a lung nodule or a pulmonary sarcoidosis, the diagnosis and treatment needs to be carried out under the guidance of a professional doctor, do not speculate on your own."
Contributed by: Li Na, Department of Respiratory and Critical Care Medicine, Second People's Hospital of Hunan Province
Editor: Cheng Jie
Image: Li Na