Restrictive lung defects: parenchymal, chest wall and neuromuscular

Area of Science:

• Pulmonary Medicine
• Radiology
• Pathology

Background:

• Sarcoidosis is a multisystem inflammatory disease affecting multiple organs.
• Cardiopulmonary manifestations are common, including parenchymal, nodal, and cardiac disease.
• Pleural involvement in sarcoidosis, such as effusions or thickening, is infrequent.

Observation:

• This report details the first documented case of active sarcoidosis presenting as bilateral pleural calcification.
• The case highlights the diagnostic challenge of coexistent pulmonary restrictions.
• Positron emission tomography (PET) scanning was utilized to identify active sarcoid lesions in the pleura.

Findings:

• Active sarcoidosis can manifest as bilateral pleural calcification, a rare presentation.
• PET scanning is valuable for localizing active disease sites, including pleural involvement.
• Tissue confirmation is crucial for diagnosing this unusual form of sarcoidosis.

Implications:

• Pleural calcification should prompt consideration of sarcoidosis in the differential diagnosis, especially when common causes are excluded.
• Understanding pulmonary physiology is key to managing patients with combined intrathoracic and extrathoracic restrictions.
• This case expands the spectrum of known sarcoidosis manifestations and emphasizes the utility of advanced imaging in diagnosis.