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Imaging Findings of Fibrosis in Pulmonary Sarcoidosis
Michiru Sawahata1, Tetsuo Yamaguchi2
1Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan.
Background:
In pulmonary sarcoidosis, respiratory tract lesions almost always appear, and residual lung shadows require treatment in about 20% of cases. Pulmonary fibrosis is among the three leading causes of death. Treatment strategies are urgently needed to inhibit the progression of pulmonary fibrosis by combining antifibrotic drugs and immunosuppressive drugs such as corticosteroids. Establishing consensus on the process of pulmonary fibrosis progression is important for determining the most effective treatment.
Our Review:
Among more than 2500 cases of sarcoidosis treated at our hospital, cases that led to chronic respiratory failure were analyzed for CT findings of pulmonary fibrosis. Early in sarcoidosis, granulomatous lesions appeared along the bronchovascular bundle. As pulmonary fibrosis progressed, a central consolidation developed on the central side in the direction of lymph flow, a peripheral consolidation developed on the pleural side, and a central-peripheral band developed connecting the two. Infiltrative or wedge-shaped shadows sometimes formed in the immediate subpleural area, appearing as a pleuroparenchymal fibroelastosis-like lesion. Traction bronchiectasis may form cysts at the periphery or may congregate to form a honeycomb lung-like structure. Combination of these lesions led to shrinkage of the upper lobe. Patients with multiple peripheral cysts/bullae had a unique disease course characterized by wheezing and concomitant pulmonary hypertension and pulmonary aspergillosis.
Conclusion:
Further understanding of the process of pulmonary fibrosis progression is needed. Summarizing imaging findings and understanding their contribution to respiratory impairment will contribute to comprehensively evaluating the stages of pulmonary fibrosis progression and establishing an optimal treatment strategy.
Insights
Pulmonary sarcoidosis can lead to pulmonary fibrosis, a leading cause of death. Understanding CT imaging findings of fibrosis progression is key to developing effective treatment strategies for this condition.
Area of Science:
- Pulmonology
- Radiology
- Pathology
Background:
- Pulmonary sarcoidosis frequently involves respiratory tract lesions.
- Pulmonary fibrosis is a significant cause of mortality in sarcoidosis patients.
- Effective treatment strategies require inhibiting fibrosis progression, potentially combining antifibrotic and immunosuppressive drugs.
Purpose of the Study:
- To analyze CT findings in sarcoidosis cases with chronic respiratory failure.
- To describe the progression of pulmonary fibrosis in sarcoidosis.
- To correlate imaging findings with disease progression and respiratory impairment.
Main Methods:
- Retrospective analysis of CT scans from over 2500 sarcoidosis patients.
- Identification of cases with chronic respiratory failure.
- Detailed description of imaging features associated with fibrosis progression.
Main Results:
- Early sarcoidosis shows granulomatous lesions along the bronchovascular bundle.
- Advanced fibrosis presents with central and peripheral consolidations, central-peripheral bands, and pleuroparenchymal fibroelastosis-like lesions.
- Traction bronchiectasis can lead to cysts, honeycomb lung, and upper lobe shrinkage. Peripheral cysts/bullae correlate with wheezing, pulmonary hypertension, and aspergillosis.
Conclusions:
- Understanding the sequential CT findings of pulmonary fibrosis progression is crucial.
- Imaging findings contribute to evaluating fibrosis stages and guiding treatment strategies.
- Further research into imaging patterns will aid in optimizing therapeutic interventions for pulmonary fibrosis in sarcoidosis.
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