New opportunities of computer tomography in diagnostics of pleural lesion in sarcoidosis

Abstract

Introduction. According to the literature, involvement in the granulomatous inflammatory process of the pleura in thoracic sarcoidosis is an unusual occurrence. The range of occurrence is from 0.08 to 10%, the median is 3%. Most often (70%) pleural sarcoidosis manifests itself as a pleural effusion. For comparison, in the publications of pathologists, pleural involvement in sarcoidosis is observed much more often – in 35% of cases. Computed tomography and, above all, multispiral computed tomography (MSCT), with a wide range of tomographic image post-processing, offers great opportunities for improving the diagnosis of sarcoidosis. Aim . The desire to acquaint with new, diverse, not known to a wide range of radiologists and pulmonologists, a set of symptoms of pleural lesions in sarcoidosis, based on 3D-reformation of tomographic images. Materials and methods .A retrospective study analysis was carried out according to a special protocol to identify pleural pathology in 140 initially verified patients with thoracic sarcoidosis. As a tool for scientific research, the DICOM archive of the Far Eastern Scientific Center of Physiology and Pathology of Respiration from 2013 to 2020 was used, containing the results of MSCT examinations of 490 patients with sarcoidosis (85% morphologically verified), which a total of 1148 studies were performed in dynamics. Results. Pleural changes were detected in 48 of 140 (34.3%) retrospectively analyzed patients. Focal and plaque granulomatous changes in the pleura are predominantly registered. Pleural effusion was found in only two patients. It has been established that the main morphological elements, as is commonly believed (WASOG, Federal Clinical Guidelines for the Diagnosis and Treatment of Sarcoidosis), are not lymphadenopathy without pulmonary pleural changes (50% at stage I), but a combination of enlarged bronchopulmonary lymph nodes, granulomatous changes in the lung parenchyma and pleura (79% in stage II). According to our data, an increase in intrathoracic lymph nodes without pulmonary lesions (stage I) and granulomatous changes without an increase in intrathoracic lymph nodes (stage III) are a rather rare condition (6 and 7%, respectively), which is confirmed by the results of X-ray morphological studies with the maximum use of post-processing. Conclusion . The results of the completed assessment of the prevalence of the combined pulmonary-pleural form of sarcoidosis are more than 10 times (34.3%) higher than the data presented in the scientific literature, and to a greater extent correspond to the results of published pathological studies (35%). A significant correction of the staging of sarcoidosis, reflecting the dominance of the X-ray morphological basic structural elements characterizing thoracic sarcoidosis, was carried out.