Chest X-ray Changes Research Articles

Clinical characteristics of lipid aspiration pneumonia in 16 children

To investigate clinical characteristics and changes of pulmonary imaging of mineral oil aspiration pneumonia in children. The clinical features, CT findings, and effects of corticosteroid therapy were analyzed in 16 children with mineral oil aspiration pneumonia, who were hospitalized in our hospital from January 2003 to July 2013. All patients with mineral oil aspiration pneumonia had a history of mineral oil administration.Four patients had no clinical manifestations. Ten cases presented fever, and 8 of the 10 patients had fever in 4-8 h after taking mineral oil, and the temperature was between 39-40 °C. There were wheezing in 2 cases, shortness of breath in 6 cases, cyanosis in 1 case, dyspnea in 3 cases, and moaning in 2 cases, chest pain in 1 case, headache and abnormal EEG in 1 case.Six patients had rales in lungs. Peripheral blood white cells increased in 10 cases, and C- reactive protein elevated in 7 patients. Chest CT examination showed abnormal findings in 6 children, and the earliest CT was performed within 2 h after the accident. The rest 10 children got chest X-ray, and 9 of 10 children had abnormal findings. The earliest X-ray was done within 3 h after the accident. And the remaining 1 of 10 children showed no significant changes in the first chest X-ray 2-3 h after the accident until 3 days. All of the patients received corticosteroid and antibiotic treatments, 4 cases underwent bronchoalveolar lavage, 3 patients were given albumin, 6 cases received intravenous immunoglobulin. Three cases delayed in treatment with hormone because of misdiagnosis, and 2 of them had clearly secondary infections. Twelve patients recovered completely from oil aspiration pneumonia after 8 days to 5.5 months. Oil aspiration pneumonia in children occurs in almost all cases after mineral oil aspiration. Pulmonary opacities can be found by chest CT in most patients within 24 hours after mineral oil aspiration. Corticosteroids therapy was effective for patients with exogenous lipid pneumonia, which may inhibit the inflammatory response and possible pulmonary fibrosis.

Study of Pressure Volume Loop in Relation to Radiological Findings among Ventilated Newborn Infants

Introduction: Pulmonary graphics monitoring of lung during mechanical ventilation have shown a reliable data among many ventilated newborn infants. Exposure of the newborn infants and NICU staff to frequent radiation from X-ray chest carries great risk. Aim of work: The aim of this study is to correlate the chest X-ray changes to the pressure –volume loop findings. Subjects and methods: Fifty five ventilated newborn infants due to pulmonary disorders as well as fifteen newborn infants due to non-pulmonary causes were included in this study. They all subjected to medical evaluation and care according to the routine of our unit. The findings from X-ray were collected as well as the pressure volume loop monitoring data at the same time. The data were collected and analyzed using SPPS. Results: There was correlation between pressure volume loop abnormalities and radiological findings of lungs. Newborn infants with RDS whose X ray chest showed a picture of white out lungs had a slit like pattern of P-V loop. Also cases with increase inspiratory resistance and radiological evidence of chronic lung diseases had widening of pulmonary P V loop. The study of pressure volume loop can indicate faulty in air flow when showed a flow starvation pattern. Segmental radiological abnormalities did not correlate with pressure volume loop anomalies. Non pulmonary cases did not show neither abnormal X-ray nor P-V loop abnormalities. Conclusion: Pressure-volume loop provides useful information on the dynamic trends of the respiratory system compliance and resistance. Modern ventilators provide complete monitoring of respiratory system mechanics, which is our guideline for optimizing ventilatory support and avoiding complications associated with mechanical ventilation. Pressure volume loop abnormal changes can correlate significantly with the generalized lung diseases. Several studies are needed to bring more evidence to our results.

Acute respiratory distress syndrome, metabolic acidosis, and respiratory acidosis associated with citalopram overdose

We report a 53-year-old man who ingested 2400 mg of citalopram and presented to the emergency department three hours post-ingestion with altered mental status, somnolence, and a blood pressure of 67/45 mmHg. He failed to respond to three boluses of normal saline (1000 ml each) and required vasopressors. The patient developed serotonin syndrome with hyper-reflexia, rigidity, and ankle myoclonus. He had a tonic-clonic seizure in the ER requiring intravenous lorazepam and phenytoin. An ECG showed QT prolongation. Chest x-ray on presentation was normal. Within 32 hours the patient developed acute respiratory distress, hypoxemia, a wide A-a gradient, PaO2/FiO2< 200, and chest x-ray changes compatible with acute respiratory distress syndrome (ARDS). He had normal central venous pressures, normal cardiac biomarkers, normal systolic and diastolic functions on echocardiography, and no acute ST/T wave changes. His ABG showed a metabolic acidosis and a respiratory acidosis. The patient required intubation and ventilation. Citalopram has been associated with seizures and ECG abnormalities after overdoses. The respiratory complications and metabolic acidosis have been reported only a few times in the literature. We are reporting the second case of ARDS and the fifth case of metabolic acidosis due to citalopram overdose and suggest that the metabolic acidemia is explained by propionic acid. The respiratory acidosis seen in this patient has not been reported previously.

English

biliary stricture have been reported in the English literature 1–11 , and only one case from the Middle East. The more common benign causes of biliary stenosis are postoperative cicatricial stenosis and complications of chronic pancreatitis, duodenal papillitis and congenital biliary dilatation. The main symptoms of tuberculosis biliary stricture including jaundice and weight loss are usually indistinguishable from those of other diseases such as cholangiocarcinoma. Although the presence of past history or chest X-ray changes of tuberculosis may raise the suspicion of this aetiology, most of the reported cases are diagnosed based on surgical pathology. We report a rare cause of common bile duct (CBD) stricture in tuberculosis of the biliary

Relevance of Routine Testing in Low-risk Patients Undergoing Minor and Medium Surgical Procedures

Background and objectives: Preoperative tests aim to reduce morbidity and mortality of surgical patients, cost of perioperative care, and preoperative anxiety. Clinical evaluation allows defining the need for additional tests and strategies to reduce the surgical-anesthetic risk. The aim of this study was to evaluate the benefit of routine preoperative testing of low-risk patients undergoing minor and medium surgical procedures. MethodsA descriptive cross-sectional study of 800 patients seen at the preanesthetic assessment department of Hospital Santo Antonio, Salvador, BA. Patients with physical status ASA I, aged 1-45 years and scheduled to undergo elective minor and medium surgeries were include in the study. We evaluated changes in blood count, coagulation profile, electrocardiogram, chest X-ray, blood sugar, kidney function, sodium and potassium levels, and eventual change in clinical approach occurring due to these changes. ResultsOf 800 patients evaluated, a blood count was performed in 97.5%, coagulation in 89%t, electrocardiogram in 74.1%, chest X-ray in 62%, fasting glucose in 68%, serum urea and creatinine in 55.7%, and plasma levels of sodium and potassium in 10.1%. Of these 700 patients, 68 (9.71%) showed changes in preoperative routine tests and only 10 (14.7%) of the patients with abnormal tests had a preoperative modified approach (i.e., new tests ordered, referral to a specialist or surgery postponement). No surgery was suspended. ConclusionWe found that preoperative additional tests are excessively ordered, even for young patients with low surgical risk, with little or no interference in perioperative management. Laboratory tests, besides generating high and unnecessary costs, are not good standardized screening instruments for diseases.

615 Congenital Lung Malformations Presenting with Similar Chest X-Ray Changes at Birth

Congenital defects of diaphragm or malformations of lung usually present in first few hours of birth and if left undiagnosed can lead to significant morbidity and mortality. Early accurate recognition...

Metal-induced asthma and chest X-ray changes in welders

The aim of this study was to evaluate the coexisting factors and usefulness of diagnostic methods in metal-induced asthma in Polish welders. Examination of 50 welders occupationally exposed to metals and with suspicion of metal-induced asthma (group A), 100 welders occupationally exposed to metals but without suspicion of metal-induced asthma (group B), and two control groups (10 patients with atopic asthma and 10 healthy subjects) was carried out. Questionnaire survey, clinical examination, skin prick tests to common aeroallergens and metal salts, rest spirometry tests, X-ray, metacholine challenge and a single-blind, placebo controlled specific inhalation challenge tests with metals (or work-like conditions challenge tests) were performed. In group A--in 9 cases we obtained positive results of specific inhalation challenge tests with metals (in 3 cases with nickel, in 4 cases with chromium, in 1 case with cobalt and in 1 case with manganese). Nine cases of metal-induced occupational asthma were recognized. In group B--only in one case we obtained positive results of work-like conditions challenge test (clinical and spirometry changes, eosinophil influx in induced sputum), which confirmed the diagnosis of occupational asthma. In most of examined welders (62%), pulmonary changes in chest X-ray images were noted. The statistical analysis revealed that working as a welder for more than 10 years is the coexisting factor of presence of chest X-ray changes (p- or q-type nodular changes or interstitial changes). Positive results of skin prick tests with metal salts were the coexisting factors of occupational asthma due to metals among examined group of welders. Specific inhalation challenge plays the key role in diagnostics of metal-induced asthma in welders. Pulmonary changes in chest X-ray were found in a significant percentage of examined welders.

P18 How effective is the recommended staging for latent TB follow-up?

Introduction NICE (2011) recommends that patients with latent TB infection who are eligible for but decline treatment are followed up with a chest x-ray (CXR) at 3 and 12 month intervals to assess for TB reactivation. The aim of this study was to assess the effectiveness of this strategy in detecting reactivation of TB. Method A retrospective case note analysis of 146 latent TB patients (2006–2011) of all ages. Mode age range 16–35 (46%). Follow-up attendance, clinical presentation, CXR appearances and patient demographics were recorded. Results 47% (n=69) attended for follow-up at 3 and 12 months. 18% DNA at 3 months, 35% DNA at 12 months. 13% moved away. 98.6% of patients showed no evidence of TB reactivation in a 12-month period. 52% of patients were under 35. 2 (1.4%) patients developed active TB within a 12-month period. One was found to have CXR changes at the 3-month follow-up, and was later admitted with TB meningitis. The other was symptomatic (no CXR changes) and was treated empirically for active TB. 63% were new entrants; 41% had been in the UK 1 patient was immunosuppressed. Common risk factors for LTBI were ethnicity (73%) and occupational exposure (19%). Only 12% recalled previous TB contact. Discussion 3 and 12-month follow-up had a very low yield of detecting TB reactivation in this sample (1.4%). It cost £16 000 (based on current PbR tariff) to screen the 69 patients who attended at 3 and 12 months. Use of limited resources must be justified. Are there better staging intervals for follow-up? Follow-up is also associated with a high DNA rate, particularly at 12 months, further stretching resources. However, follow-up allows health promotion regarding TB symptoms and the role of chemoprophylaxis. Conclusion These results question the validity of following up LTBI patients at 3 and 12 months after diagnosis. Further longitudinal studies are needed to determine the optimum intervals for follow-up.

Pneumonia in the developed world

In this paper, we review the literature on the management of pneumonia in the developed world setting. Pneumonia is usually diagnosed on the basis of a cough, respiratory distress, a fever, and chest X-ray changes. Pneumonia affects all paediatric age groups, though the highest incidence is in the under 5s. There is a significant burden of primary and secondary care illness, although mortality is low. Inpatient admission rates for pneumonia may have increased in recent years in some regions. Pneumonia is unlikely if a child presents with solely wheeze. In routine clinical practice, a microbiological diagnosis is often not made, because current tests are insensitive. Aetiology varies with geographical location, but approximately half of cases are viral. The mainstay of management of moderate pneumonia (the commonest group presenting to secondary care) is careful assessment, and oral antibiotics, followed by early discharge when the patient shows signs of improvement. We summarise the available clinical trial data from the developed world; most of these trials are not adequately powered. Patients with moderately severe pneumonia do not require invasive investigation, but clinical judgement should be used to identify and investigate more complex cases. We discuss several pathogens that have gained importance as causal agents, including non-vaccinated strains of S. pneumoniae, Panton Valentine leucocidin S. aureus, H1N1 Influenza A and Human Bocavirus. The importance of antimicrobial resistance is considered, and we review recent data on long term effects of pneumonia in childhood. By reviewing the available literature, we demonstrate that there are clear evidence gaps, and we suggest future areas for clinical research.

Mortality among sheet metal workers participating in a medical screening program

The Sheet Metal Occupational Health Institute Trust (SMOHIT) was formed in 1985 to examine the health hazards of the sheet metal industry in the U.S. and Canada through an asbestos disease screening program. A study of mortality patterns among screening program participants was undertaken. A cohort of 17,345 individuals with 20 or more years in the trade and who participated in the asbestos disease screening program were followed for vital status and causes of death between 1986 and 2004. Data from the screening program included chest X-ray results by International Labour Office (ILO) criteria and smoking history. Standardized mortality ratios (SMRs) by cause were generated using U.S. death rates and Cox proportional hazards models were used to investigate lung cancer risk relative to chest X-ray changes while controlling for smoking. A significantly reduced SMR of 0.83 (95% CI = 0.80-0.85) was observed for all causes combined. Statistically significant excess mortality was observed for pleural cancers, mesothelioma, and asbestosis in the SMR analyses. Both lung cancer and COPD SMRs increased consistently and strongly with increasing ILO profusion score. In Cox models, which controlled for smoking, increased lung cancer risk was observed among workers with ILO scores of 0/1 (RR = 1.17, 95% CI = 0.89-1.54), with a strong trend for increasing lung cancer risk with increasing ILO profusion score >0/0. Sheet metal workers are at increased risk for asbestos-related diseases. This study contributes to the literature demonstrating asbestos-related diseases among workers with largely indirect exposures and supports an increased lung cancer risk among workers with low ILO profusion scores.

Safety and efficacy of inhaled insulin (AERx® iDMS1) compared with subcutaneous insulin therapy in patients with Type 1 diabetes: 1‐year data from a randomized, parallel group trial

Assessment of the long-term safety and efficacy of liquid inhaled insulin via AERx insulin Diabetes Management System (iDMS) in a basal/bolus treatment regimen of adults with Type 1 diabetes. Patients were randomized 2 : 1 to prandial inhaled (n = 205) or subcutaneous (s.c.) (n = 99) insulin, plus one/two daily injections of neutral protamine Hagedorn (NPH) insulin for 12 months. The primary endpoints were pulmonary function tests (PFT) and baseline changes in chest X-rays at 12 months. Safety and efficacy assessments were measured at regular intervals. PFTs after 12 months were comparable between the groups, except for reduced per cent of predicted carbon monoxide lung diffusing capacity with inhaled insulin (difference: -2.03%, P = 0.04) occurring after the first 3 months and then stabilizing. There were no apparent treatment differences in chest X-rays. Overall risk of hypoglycaemia [risk ratio (RR) 1.02, P = 0.83] and adverse events were comparable between groups. Risk of nocturnal hypoglycaemia was higher in the inhaled group (RR 1.58, P = 0.001). Cough [10% (inhaled); 3% (s.c.)] tended to be mild in nature. Inhaled insulin was non-inferior to s.c. insulin for change in glycated haemoglobin (HbA(1c)) after 12 months [difference 0.18% (CI 95%-0.04; 0.39)]. At trial end, mean laboratory measured fasting plasma glucose was lower in the inhaled group (inhaled 9.2 mmol/l; s.c. 11.7 mmol/l; difference: -2.53 mmol/l, P < 0.001). The safety and efficacy results in this trial were similar to those reported with other inhaled insulins; however, inhaled insulin using AERx iDMS requires further optimization to reduce nocturnal hypoglycaemia before it has comparable safety and efficacy to s.c. insulin aspart.

Changes in lung function and chest X-ray of workers exposed to asphalt fume

目的 探讨沥青烟作业工人肺通气功能和X线胸片的改变.方法 选择碳素分厂生阳极车间接触沥青烟工人53名作为接触组,选择该厂非沥青烟作业职工50名作为对照组,比较两组肺通气功能和胸部X线片的变化.结果 接触组肺活量(VC)、用力肺活量(FVC)、1秒钟用力呼气量(FEV10)、最大自主通气量(MVV)的异常率分别为34.0%、30.2%、35.8%、37.7%,对照组的异常率分别为10.0%、16.0%、12.0%、10.0%,两组比较,差异有统计学意义(P＜0.01).与对照组比较,接触组VC、MVV、FEV10明显降低,差异有统计学意义(P＜0.05或P＜0.01).接触组FEV10与接触工龄呈负相关(r=-0.321,P＜0.05),MVV与接触工龄呈负相关(r=-0.287,P＜0.05).接触组肺纹理改变阳性检出率为34.0%,对照组肺纹理改变阳性检出率为16.0%,两组比较,差异有统计学意义(P＜0.05).接触工龄5～20年组和＞20年组肺纹理改变阳性胸片检出率均高于＜5年组,差异均有统计学意义(P＜0.05).结论 沥青烟能引起作业工人肺通气功能的改变,与接触工龄有关。

Successful treatment of cepacia syndrome with combination nebulised and intravenous antibiotic therapy

We report the case of successful treatment of a 31-year-old lady with cystic fibrosis and an en-bloc liver–pancreas transplant, who developed cepacia syndrome on a background of chronic infection with the ET12 epidemic strain of Burkholderia cenocepacia. Combination therapy with nebulised and intravenous meropenem and tobramycin led to clinical improvement with a return to baseline function and complete resolution of the acute chest X-ray changes.

The role of intralesional Pingyangmycin in the treatment of venous malformation of facial and maxillary region

To investigate the effect of intralesional Pingyangmycin injection in venous malformation of facial and maxillary region. From September 2001 to October 2004, 82 patients were referred with venous malformation for intralesional Pingyangmycin injection. After a minimum follow-up of 2 years, 67 patients (81.7%) developed 76-100% regression in their lesions; 12 patients (14.6%) had 51-75% regression in their lesion; 3 patients underwent surgical excision for the residual swellings. No changes in renal function or cytopenias were encountered. No patients developed chest X-ray changes during the course of therapy. There were no mortalities. Intralesional injection of Pingyangmycin is an effective, inexpensive, and safe method in venous malformation of facial and maxillary region. We now favor Pingyangmycin sclerotherapy before considering surgical excision in all cases of venous malformation in our hospital.

Chronic lung disease in human immunodeficiency virus (HIV) infected children

The development of chronic lung disease is common in HIV-infected children. The spectrum of chronic HIV-associated lung disease includes lymphocytic interstitial pneumonia (LIP), chronic infections, immune reconstitution inflammatory syndrome (IRIS), bronchiectasis, malignancies, and interstitial pneumonitis. Chronic lung disease may result from recurrent or persistent pneumonia due to bacterial, mycobacterial, viral, fungal or mixed infections. In high tuberculosis (TB) prevalence areas, M. tuberculosis is an important cause of chronic respiratory illness. With increasing availability of highly active antiretroviral therapy (HAART) for children in developing countries, a rise in the incidence of IRIS due to mycobacterial or other infections is being reported. Diagnosis of chronic lung disease is based on chronic symptoms and persistent chest X-ray changes but definitive diagnosis can be difficult as clinical and radiological findings may be non-specific. Distinguishing LIP from miliary TB remains a difficult challenge in HIV-infected children living in high TB prevalence areas. Treatment includes therapy for specific infections, pulmonary clearance techniques, corticosteroids for children with LIP who are hypoxic or who have airway compression from tuberculous nodes and HAART. Children who are taking TB therapy and HAART need adjustments in their drug regimes to minimize drug interactions and ensure efficacy. Preventative strategies include immunization, chemoprophylaxis, and micronutrient supplementation. Early use of HAART may prevent the development of chronic lung disease.

Risk factors for respiratory disease in chronic psychiatric in patients

Objective: Individuals with schizophrenia and other chronic mental illnesses present a series of risk factors, that predispose them to extensive medical comorbidity. The aim of this study was to determine the risk factors for respiratory disease in chronic psychiatric inpatients. Methods: All patients at a long-term mental institution were invited to participate in this study. Socio-demographic data, tobacco and alcohol consumption, respiratory symptoms and chest x-rays were collected from 154 patients. Sputum microscopy and cultures for M. tuberculosis were done in specific cases. Results:The symptoms reported were cough (58%); expectoration (44.2%); dyspnea (28.6%); hemoptysis (9.7%), and chest pain (20.1%). There were chest x-ray changes in 57.1% of patients. These were suggestive of chronic obstructive pulmonary disease (COPD) in 31.2% and an interstitial pattern in 19.1%. The prevalence of tuberculosis in this sample was 4.5%. Schizophrenia was the most common mental illness (43.5%), followed by an organic mental disorder (32.5%). We found a positive relationship between schizophrenia and cigarette smoking (odds ratio 2.30, 95% CI 1.11 to 4.76), and schizophrenia and x-ray changes (odds ratio 2.35,95% CI 1.15 to 4.83). There was no significant relationship with other psychiatric disorders. Conclusions: The high prevalence of respiratory morbidity in patients with chronic mental illness hospitalized in long-term care facilities, is probably due to factors such as extreme poverty, tobacco consumption, overcrowding, and nutritional deficit.

Investigation of children with chronic nonspecific cough: Any clinical benefit of bronchoscopy and bronchoalveolar lavage?

Chronic cough can be a complicated and frustrating diagnostic dilemma. The aim of this study was to identify the possible causes of chronic nonspecific cough in seemingly healthy children using fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL). Eighteen children responded to criteria of selection for chronic cough. The average age was 5.8 years (range, 1.7-10.7 years) and BAL findings were compared with those of 16 nonatopic controls. Children with chronic cough had an increased percentage of BAL neutrophils in comparison with the control group (p = 0.098). Using a BAL neutrophil percent cutoff of 17%, 6 children had high BAL neutrophils (HBNs; median, 77%; range, 27-96%) and 12 children had normal BAL neutrophils (NBNs; median, 3%; range, 0-13%). In the HBN group, FOB showed endoscopic abnormalities in four patients, BAL culture was positive in three patients, and chest x-ray (CXRs) showed minimal densities in four. The IL-8 levels showed a significant increase with respect to the NBN group (p = 0.005). The combination of endoscopic anomalies, BAL culture, BAL IL-8 levels, and minor CXR changes can support the diagnosis of subclincal infection in seemingly healthy children with chronic nonspecific cough and HBN.

The Diagnostic Yield and Clinical Impact of a Chest X-Ray after Percutaneous Dilatational Tracheostomy: A Prospective Cohort Study

A chest X-ray (CXR) is routinely performed after percutaneous dilatational tracheostomy (PDT). The purpose of this study was to evaluate the diagnostic yield of routine CXR following PDT and its impact on patient management and to identify predictors of post-PDT CXR changes. Two-hundred-and-thirty-nine patients who underwent PDT in a 21-bed intensive care unit were included prospectively in the study. The following data were collected: patient demographics, APACHE III scores, pre-PDT FiO2 and PEEP, PDT technique, perioperative complications and the use of bronchoscopic guidance. We compared post-PDT CXR with the last pre-PDT CXR. We documented any post-PDT new radiographic findings including atelectasis, pneumothorax, pneumomediastinum, surgical emphysema, pulmonary infiltrates or tracheostomy tube malposition. We also recorded management modifications based on post-PDT radiographic changes, including increased PEEP, chest physiotherapy, therapeutic bronchoscopy or chest tube insertion. Atelectasis was the only new finding detected on post-PDT CXRs of 24 (10%) patients. The new radiographic findings resulted in a total of 14 modifications of management in 10 (4%) patients including increased PEEP in six, chest physiotherapy in six and bronchoscopy in two patients. Trauma and pre-PDT PEEP >5 cmH2O were independent predictors of post-PDT CXR changes. Routine CXR following PDT has a low diagnostic yield, detecting mainly atelectasis and leading to a change in the management in only a minority ofpatients. Routine CXR after apparently uncomplicated PDT performed by an experienced operator may not be necessary and selective use may improve its diagnostic yield. Further studies are required to validate the safety of selective versus routine post-PDT CXR.

Children with pneumonia: how do they present and how are they managed?

Objective: To describe the spectrum of clinical features and management of community acquired pneumonia in the UK. Design: Prospectively recorded clinical details for all children with possible pneumonia and chest...

Sarkoidoza ślinianki przyusznej

Sarcoidosis is a granulomatous multisystemic disease of unknown origin that can occur in any organ of the body and commonly affects young adults. Pulmonary sarcoidosis is by far the most common manifestation of the disease but occasionally it presents with involvement of the lymph nodes, skin, eyes, liver, spleen, heart, bones, joints, nervous system and the oral organs. The diagnosis of sarcoidosis is complex and includes the presence of noncaseating granuloma in involved tissues, changes in chest x-ray and many other tests. The aim of the study was to present the rare case of parotid sarcoidosis which was the origin of discussion of diagnostics and treatment of sarcoidosis in ENT field. The authors present a review of updated opinions on pathogenesis, diagnostics and treatment of sarcoidosis, completed with own experience concerning a case of extrapulmonary sarcoidosis that manifested with isolated parotid gland enlargement. 1. The incidence of head and neck sarcoidosis is rare, although this etiology should be taken into account in ENT diagnostics. 2. The lesions can occur in many organs, most common manifestation is: lungs, peripherial lymph nodes, skin, eyes, articulations, liver and spleen. 3. Course of sarcoidosis is not characteristic, chest x-ray, biopsy and the analysis of clinical signs are required to settle the diagnosis. 4. In cases of isolated salivary gland sarcoidosis the preoperative diagnosis is difficult, fine-needle biopsy and Doppler ultrasonography can be helpful. 5. The possibility of exacerbations and recidivations makes the long follow-up necessary.