Lymphography in Sarcoidosis: Comparison with Roentgen Findings in the Chest

Abstract

THE PREVALENCE of sarcoidosis in Japan is 5.6 per 100,000. This is far lower than that of other countries, e.g., 64.0 in Sweden and 26.7 in Norway (1, 2). Schaumann considered sarcoidosis a systemic disease, attacking particularly the reticuloendothelial system, but Iwai and Oka (3) found in autopsy studies that only the tracheomediastinal lymph nodes are uniformly involved. This study is concerned primarily with the lymphographic findings in patients with this granulomatous disease of unknown etiology. The characteristic lymphographic appearance is described and compared with the chest roentgenograms, especially in respect to hilar node enlargement. Methods and Materials From May 1965 to June 1968, lymphography was performed in 15 cases of sarcoidosis, all with pulmonary lesions. Radiographs were taken immediately and twenty-four hours after the injection of 10 ml of Ethiodol into the dorsum of each foot by Kinmonth's method, with visualization of the major retroperitoneal lymph node groups. The diagnostic criterion of sarcoidosis was based on three major factors: chest findings specific for sarcoidosis (bilateral peribronchial lymph node enlargement and/or parenchymal lesions), the Kveim test, and organ biopsy (presence of epithelioid cell tubercles showing little or no necrosis), supported by such data as uveitis, negative tuberculin test, hyper-globulinemia, and hypercalcemia. The 15 cases which constitute the present series were grouped according to the system proposed at the Second International Conference on Sarcoidosis as follows: Group I, in which both the Kveim test and organ biopsy were positive (5 cases) ; Group II, in which the Kveim test was positive and organ biopsy was negative or omitted (1 case) ; Group III, in which organ biopsy was positive and the Kveim test was negative or omitted (6 cases) ; Group IV, in which both the Kveim test and organ biopsy were negative or omitted (3 cases). Chest findings were based on routine roentgen examination supplemented by laminagraphy and magnification roentgenography. To follow the course of the disease, films of the chest made prior to the diagnosis of sarcoidosis were retrospectively studied as far as available, and the course subsequent to lymphography was observed, especially to record the effects of steroid therapy. Results Lymphographic Findings (a) Abnormal Findings in the Lymphadenograms of the Retroperitoneal and Iliac Nodes: These can be classified into the following three patterns : 1. A marked enlargement of retroperitoneal nodes (Fig. 1, CASE 1) comparable in size to the hilar adenopathy. The nodes show sharply defined multiple central filling defects (see full description, CASE 1).