The natural history of pulmonary sarcoidosis is not well delineated, the disease is known to be chronic, with a tendency to wax and wane over time. Chest radiographs are often performed to assess disease evolution, and are utilized in the decision making process for initiating treatment. Insufficient data is currently available to predict disease progression based on radiographic pattern and staging.
We conducted a retrospective study of all pulmonary sarcoidosis patients evaluated at a tertiary care centre. Patients who had radiographic and PFT data at presentation and at 18 months of follow up, were included. Two pulmonary radiologists analyzed the chest radiographs according to Scadding’s staging and a scoring system based on predominance of nodular opacities, alveolar infiltrates and linear opacities. Based on radiological scoring and PFT interpretation, the patients were graded as deteriorated, stable or improved.
Out of a total of 42 patients, 26 had complete data set available for analysis. The outcome is presented in the following table
Outcome of SarcoidosisDeteriorationStabilityImprovementTreatment42.9%42.9%14.3%No treatment12.5%62.5%25%Nodular opacities20%40%40%Alveolar infiltrates16.7%50%33.3%Linear opacities25%50%25%.CONCLUSIONS: At 18 months follow up, most patients remained stable; whereas, a smaller number improved or deteriorated. Either treatment or radiographic pattern did not influence outcome in patients with pulmonary sarcoidosis.
Pulmonary sarcoidosis is a chronic disease process with a variable clinical course. Treatment decision should not be based solely on the radiographic appearance or progression.
N. Marten, None.