Skip to main content

Advertisement

Log in

The Clinical and Radiologic Features of Nodular Pulmonary Sarcoidosis

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Study Objectives Nodular sarcoidosis is an uncommon presentation of sarcoidosis. Our objective was to describe the clinical characteristics of a large cohort of patients with nodular sarcoidosis. Methods We performed a retrospective study of patients with nodular sarcoidosis diagnosed at an urban teaching hospital over a 10-year period. Results Thirty-three patients with nodular sarcoidosis were identified. All patients were African-American. The mean age was 35 and the female-to-male ratio was 5:1. Twenty-six patients were current or former smokers. All patients had chest CT scan and/or chest radiograph evidence of pulmonary masses. Twenty-seven patients had multiple pulmonary masses/nodules and six had solitary pulmonary nodules/masses. The upper lobes were involved in 27 patients. Mediastinal lymphadenopathy and pleural-based masses were present in 30 and 20 patients, respectively. Extrapulmonary manifestations were present in 14 patients. All patients had tissue diagnosis of noncaseating granulomas with negative culture. Twenty-two patients underwent bronchoscopy with transbronchial biopsies, which were diagnostic in 19. Follow-up data were available on 27 patients: complete or nearly complete resolution of the pulmonary masses—either spontaneously or with systemic treatment—was documented for 19 patients, no change in the radiologic findings for 7 patients, and progression to pulmonary fibrosis for 1 patient. Conclusions Nodular sarcoidosis is a rare presentation of pulmonary sarcoidosis. It usually presents with multiple pulmonary masses that tend to be peripheral and are associated with mediastinal lymphadenopathy. Bronchoscopy with transbronchial biopsies has high diagnostic yield. Despite its ominous presentation, nodular sarcoidosis has favorable prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. American Thoracic Society (1999) Statement on sarcoidosis. Am J Respir Crit Care Med 160:736–755

    Google Scholar 

  2. Scadding JG (1961) Prognosis of intrathoracic sarcoidosis in England: A review of 136 cases after 5 years observation. BMJ 5261:1165–1172

    Google Scholar 

  3. Hansell DM, Armstrong P, Lynch DA, McAdams HP (eds) (2005) Miscellaneous lung diseases: sarcoidosis. In: Imaging of diseases of the chest, 4th edn, chap 11, Mosby, Philadelphia, pp 631–653

  4. Sharma OP, Hewlett R, Gordonson J (1973) Nodular sarcoidosis: an unusual radiographic appearance. Chest 64:189–192. doi:10.1378/chest.64.2.189

    Article  PubMed  CAS  Google Scholar 

  5. McCord MC, Hyman HL (1952) Pulmonary sarcoidosis with the roentgenologic appearances of metastatic neoplasm; a report of two cases. Am J Roentgenol Radium Ther Nucl Med 67(2):259–262

    PubMed  CAS  Google Scholar 

  6. Nakamura H, Kashiwabara K, Watanabe T, Yagyu H, Kiguchi T, Matsuoka K (1995) Sarcoidosis with multiple nodular shadows in bilateral lung fields. Intern Med 11:1144–1145. doi:10.2169/internalmedicine.34.1144

    Article  Google Scholar 

  7. Onal E, Lopata M, Lourenco RV (1977) Nodular pulmonary sarcoidosis: clinical, roentgenographic, and physiologic course in five patients. Chest 72:296–300

    Article  PubMed  CAS  Google Scholar 

  8. Rose RM, Lee RG, Costello P (1985) Solitary nodular sarcoidosis. Clin Radiol 36:589–592

    Article  PubMed  CAS  Google Scholar 

  9. Kurogouchi F, Fujimori Y, Oharazawa A, Nagasaki M, Miyazawa K, Sano K, Kubo K, Kiyosawa K (1998) Sarcoidosis associated with multiple large pulmonary nodules. Respirology 3:273–276

    Article  PubMed  CAS  Google Scholar 

  10. McCullough PC, McCullough AE (2002) Nodular sarcoidosis. N Engl J Med 346:1970

    Article  PubMed  Google Scholar 

  11. Nutting S, Carr I, Cole FM, Black LL (1979) Solitary pulmonary nodules due to sarcoidosis. Can J Surg 22:584–586

    PubMed  CAS  Google Scholar 

  12. Murin S, Bilello KS, Matthay R (2000) Other smoking-affected pulmonary diseases. Clin Chest Med 21:121–137

    Article  PubMed  CAS  Google Scholar 

  13. Valeyre D, Soler P, Clerici C, Pré J, Battesti JP, Georges R, Hance AJ (1988) Smoking and pulmonary sarcoidosis: effect of cigarette smoking on prevalence, clinical manifestations, alveolitis, and evolution of the disease. Thorax 43:516–524

    Article  PubMed  CAS  Google Scholar 

  14. Douglas JG, Middleton WG, Gaddie J, Petrie GR, Choo-Kang YF, Prescott RJ, Crompton GK (1986) Sarcoidosis: a disorder commoner in non-smokers? Thorax 41:787–791

    Article  PubMed  CAS  Google Scholar 

  15. Hance AJ, Basset F, Saumon G, Danel C, Valeyre D, Battesti JP, Chrétien J, Georges R (1986) Smoking and interstitial lung disease: the effect of cigarette smoking on the incidence of pulmonary histiocytosis X and sarcoidosis. Ann N Y Acad Sci 465:643–656

    Article  PubMed  CAS  Google Scholar 

  16. Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H (1989) Pulmonary sarcoidosis: evaluation with high-resolution CT. Radiology 172:467–471

    PubMed  CAS  Google Scholar 

  17. Battesti JP, Saumon G, Valeyre D, Amouroux J, Pechnick B, Sandron D, Georges R (1982) Pulmonary sarcoidosis with an alveolar radiographic pattern. Thorax 37:448–452

    Article  PubMed  CAS  Google Scholar 

  18. Brincker H (1986) Sarcoid reactions in malignant tumors. Cancer Treat Rev 13:147–156

    Article  PubMed  CAS  Google Scholar 

  19. Liebow A (1973) The J. Burns Amberson lecture: pulmonary angiitis and granulomatosis. Am Rev Respir Dis 108:1–18

    PubMed  CAS  Google Scholar 

  20. Chittock DR, Joseph MG, Paterson NA, McFadden RG (1994) Necrotizing sarcoid granulomatosis with pleural involvement. Chest 106:672–676

    Article  PubMed  CAS  Google Scholar 

  21. Popper HH, Klemen H, Colby TV, Churg A (2003) Necrotizing sarcoid granulomatosis—is it different from nodular sarcoidosis? Pneumologie 57:268–271

    Article  PubMed  CAS  Google Scholar 

  22. Churg A, Carrington CB, Gupta R (1979) Necrotizing sarcoid granulomatosis. Chest 76:406–413

    Article  PubMed  CAS  Google Scholar 

  23. Heinrich D, Gordjani N, Trusen A, Marx A, Hebestreit H (2003) Necrotizing sarcoid granulomatosis: a rarity in childhood. Pediatr Pulmonol 35:407–411

    Article  PubMed  CAS  Google Scholar 

  24. Lynch JPIII, Kazerooni EA, Gay SE (1997) Pulmonary sarcoidosis. Clin Chest Med 18:755–785

    Article  PubMed  Google Scholar 

  25. Gal AA, Koss MN (2002) The pathology of sarcoidosis. Curr Opin Pulm Med 8:445–451

    Article  PubMed  Google Scholar 

  26. Romer FK (1977) Sarcoidosis with large nodular lesions simulating pulmonary metastases: an analysis of 126 cases of intrathoracic sarcoidosis. Scand J Respir Dis 58:11–16

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ayman O. Soubani.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Malaisamy, S., Dalal, B., Bimenyuy, C. et al. The Clinical and Radiologic Features of Nodular Pulmonary Sarcoidosis. Lung 187, 9–15 (2009). https://doi.org/10.1007/s00408-008-9118-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-008-9118-2

Keywords

Navigation