Intrathoracic Sarcoidosis

A Review of 69 Cases

¹ Associate Physician, Division of Pulmonary Diseases

In a series of 69 cases of intrathoracic sarcoidosis diagnosed between 1955 and 1961, the diagnosis was generally made on the basis of a consistent clinical picture, roentgenographic findings of hilar lymph node enlargement and/or pulmonary involvement and the finding of noncaseating epithelioid tubercles in biopsied tissue.

The most common symptoms were cough, fatigue, dyspnea, weight loss, and fever or sweats. One-fifth had no symptom at the time of diagnosis.

Elevation of serum globulin, particularly the gamma fraction was the most consistent laboratory abnormality.

Eight subjects had a close relative who had had tuberculosis. In 17 per cent of 64 cases, the tuberculin test was positive. In only three of 47 was the histoplasmin skin test positive.

Ninety-one biopsies were made in 68 subjects. Scalene node biopsy revealed epithelioid tubercles in 40 of 44 cases in which it was done.

A variety of pulmonary involvement was seen, including local and widespread disease, ranging from fine to coarse shadows. Evidence of no change or progression of disease was noted in 21 of 32 with a two-year or more follow-up.

Five of the 69 subjects had erythema nodosum.

Pulmonary function abnormalities included both restrictive and obstructive phenomena and blood gas abnormalities.

Extrathoracic sarcoidosis (exclusive of liver or lymph nodes) was demonstrated in nearly one-fourth of the subjects, more often in Negroes.

Five persons are known to have died, four from cardiopulmonary causes.