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Functional Significance of the Decreased Attenuation Sign on Expiratory CT in Pulmonary Sarcoidosis*: Report of Four Cases

Piera Fazzi, MD; Paola Sbragia, MD; Stefano Solfanelli, BS; Settimio Troilo, MD; Carlo Giuntini, MD, FCCP
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*From the Cardiac and Thoracic Department (Drs. Fazzi, Troilo, and Giuntini and Mr. Solfanelli), Respiratory Pathophysiology Section, and the Department of Oncology (Dr. Sbragia), Radiodiagnostic Section, University of Pisa, Italy.

Correspondence to: Piera Fazzi, MD, Cardiac and Thoracic Department, Pathophysiology Section, Via Paradisa 2, Cisanello Hospital, 56124 Pisa, Italy; e-mail: c.giuntini@med.unipi.it



Chest. 2001;119(4):1270-1274. doi:10.1378/chest.119.4.1270
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We describe four patients with proven sarcoidosis and minor pulmonary involvement according to high-resolution CT (HRCT) findings in whom the recently described sign of decreased attenuation on expiratory HRCT scan appeared associated with the reduction of the single-breath diffusing capacity of the lung for carbon monoxide (Dlco) and the Dlco adjusted for alveolar volume. These alterations were, in part, reversible under steroid treatment. Major indexes of airway obstruction (FEV1/vital capacity ratio and FEV1) were normal, while the maximum expiratory flow at 25% above the residual volume of FVC was reduced. These observations suggest that an expiratory HRCT mosaic pattern and diffusion impairment may be early findings in pulmonary sarcoidosis and may be useful for its detection and follow-up.

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