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Case based discussions
Restrictive lung defects: parenchymal, chest wall and neuromuscular
  1. Anne-Marie Shanks1,
  2. Sujal R Desai2,
  3. Alexandra Rice3,
  4. Stephen R Thomas1,
  5. Michael I Polkey1,4,
  6. Peter M George5
  1. 1 Thoracic Medicine, Raigmore Hospital, Inverness, UK
  2. 2 Department of Radiology, Royal Brompton Hospital, London, UK
  3. 3 Department of Pathology, Royal Brompton Hospital, London, UK
  4. 4 Department of Sleep and Ventilation, Royal Brompton Hospital, London, UK
  5. 5 Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
  1. Correspondence to Dr Peter M George, Interstitial Lung Disease Unit, Royal Brompton Hospital, London SW3 6NP, UK;{at}


Sarcoidosis is a multisystem condition which may affect a number of organs and, within the cardiopulmonary system, most commonly manifests as parenchymal, airway-centred, nodal, vascular or cardiac disease. Pleural involvement is rare, but well described, and often presents as pleural effusions or pleural thickening. Here, we present the first case of active sarcoidosis manifesting as bilateral pleural calcification. We highlight the importance of a nuanced understanding of pulmonary physiology when dissecting coexistent extrathoracic and intrathoracic pulmonary restriction. We demonstrate the value of positron emission tomography scanning for identification of sites of sarcoid activity, in this case the pleura, to ensure tissue confirmation of this rare but functionally important manifestation of disease. Sarcoidosis should be considered within the differential diagnosis for patients with pleural calcification, not explained by more common causes.

  • sarcoidosis
  • lung physiology
  • pleural disease
  • interstitial fibrosis
  • imaging/ct mri etc

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  • SRT, MIP and PMG contributed equally.

  • Twitter Please follow Peter M George @DrPeteGeorge

  • Contributors All authors were involved in the clinical care of the patient and cowrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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