Primary acute pulmonary cavitation in sarcoidosis

Sarcoidosis has a variety of pulmonary manifestations including the nodular or acinar form. Occasionally this primary granulomatous process may cavitate. Six cases are described in the literature and three more are added in this report. The pathogenesis may be on the basis of ischemic or eosinophilic necrosis of conglomerate granulomas. Diagnosis requires the exclusion of other causes of cavitation such as neoplasm, mycobacteria, and fungi. The cavities are rather easily distinguished from dilated bronchi and bullae which may develop in chronic fibrotic sarcoidosis. Primary cavitating sarcoid usually occurs in young individuals with acinar or nodular disease elsewhere. The cavities are usually round, smooth-walled, and 3-5 cm in diameter. Fluid is not a prominent feature: regression with steroid treatment is not extensive as with other infiltrates. Thin-walled cavities may persist months after treatment.