Tuesday, June 13, 2006
Sarcoidosis question
A 59 year old caucasian man is referred for cough and dyspnea. He carries a diagnosis of sarcoidosis at least back to 1999 but has never had a biopsy. Let's assume the spiro is a restrictive pattern. Based on the following chest xray, would you do anything else to more definitively confirm the diagnosis or would you be satisfied as it is?
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3 comments - CLICK HERE to read & add your own!:
I always question these remote diagnoses at their face value. Not that I don't trust whoever made them in the first place but rather because so much can happen in 7 years...
I would probably err on the side of reinventing the wheel a bit and at least obtaining a HRCT and perhaps even further diagnostic confirmation depending on those results.
Well, based on the above CXR, what additional info would you get from the HRCT? Is there anything there that will steer you away from a sarcoid diagnosis (or towards another dx)? What else would cause the above CXR findings? I MAY go for a TBBX but not sure about that either...
I think you always get a little more data from the HRCT that may help treatment (stuff like finding more bronchiectatic changes than one can see on CxR that may benefit from chest P&PD). I think the bronch would help you exclude superimposed disorders: people can have sarcoid and infections at the same time.
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