Clinical Manifestations, Pathophysiology, Diagnostic Methods, Imaging and Intervention in Sarcoidosis


Ali Nawaz Khan (Editor)
Consultant Radiologist, Professor Honorary, North Manchester General Hospital, UK

Series: New Developments in Medical Research
BISAC: MED083000

Sarcoidosis is a multisystem granulomatous disease of unknown etiology that is characterized by noncaseous epithelioid cell granulomas, which may affect almost any organ in the body. Intrathoracic involvement is common and accounts for most of the morbidity and mortality associated with this disease. The diagnosis is based on the total exclusion of other granulomatous disorders. The organs that are commonly involved are the lymph nodes, lungs, liver, spleen, skin, and eyes; these organs can be involved individually or in combination. The correlation of the clinical, radiological features along with the pathologic finding of non-caseating epithelioid cell granulomas is vital to establish the diagnosis. There is no single precise cause attributed to the causation of this disease. Genetic factors are suspected, due to the observation that racial groups such as African Americans, West Indians and Asians have a higher prevalence of sarcoidosis.

Familial sarcoidosis is well-known, which may be attributed to genetic factors or the sharing of a similar environment. Environmental factors may also play a role by involving the uptake and processing of unknown antigens by the respiratory system. Occasional patients with sarcoidosis have an association with primary biliary cirrhosis, where the granulomas in both diseases look similar. Patients receiving treatment with anti-retroviral therapy or interferon alpha might have pulmonary granulomas as in HIV-infected patients and leukemia patients retrospectively. Sarcoidosis is more prevalent and is a more severe disease in blacks in the United States of America. Two-thirds of patients with sarcoidosis resolve spontaneously without specific treatment. Therapeutic measures, when required, rely on immune suppression.

As the symptoms are varied in sarcoidosis, the differential diagnosis includes most non-specific systemic disorders. A chest radiograph (CXR) is usually the first diagnostic imaging study in patients with respiratory symptoms. A CXR is a non-invasive modality, widely available, easy to interpret and when correlated with the clinical findings, may be the only imaging required to diagnose pulmonary sarcoidosis. A CXR is also the most commonly used imaging technique for follow-up in patients with established diagnosis, and is reproducible and cost efficient. Conventional chest radiography, however, has its limitations. While it may be normal in 5-10% of patients with established sarcoidosis, in 25-30% of patients, the radiologic changes are nonspecific or atypical reducing the plain film sensitivity. In such cases, High-Resolution CT (HRCT) is useful in clarifying the diagnosis providing crucial information on the extent of the disease. Furthermore, HRCT, unlike a plain radiograph, can readily differentiate active inflammation from irreversible fibrosis. (Imprint: Nova Biomedical)

Table of Contents

Table of Contents


Chapter 1. A Pathologist’s Approach to Pulmonary Sarcoidosis
Hanaa Bamefleh (Consultant in Anatomic Pathology and Pulmonary Pathology, King Abdulaziz Medican City (KAMC), Riyadh, Saudi Arabia)

Chapter 2. Clinical Manifestations, Diagnostic Methods and Management of Pulmonary Sarcoidosis
Nahid Sherbini, Hamdan AL-Jahdali, and Ali N Khan (Department of Medicine, Pulmonary Division, King Saud University for Health Sciences, King Abdulaziz Medical City – Riyadh, Saudi Arabia, and others)

Chapter 3. The Chest Radiograph in the Diagnosis and Staging of Thoracic Sarcoidosis
Zeid Al-Ani and Syahminan Suut (logy Registrar North West Radiology Training Scheme, Manchester, UK, and others)

Chapter 4. The Role of HRCT in Pulmonary Sarcoidosis
Carolyn Allen, Ali Nawaz Khan and Ayan Sabih (Consultant Thoracic Radiologist & Clinical Director North Manchester General Hospital, UK, and others)

Chapter 5. Saprophytic Aspergillosis (Aspergilloma)
Sumaira Macdonald, Abeeku Afedzi Hammond, and Ali Nawaz Khan (Consultant Endovascular Medicine and Chief Medical Officer Silk Road Medical Sunnyvale, California, USA, and others)

Chapter 6. Genitourinary Manifestations of Sarcoidosis: Symptomatology and Diagnostic Imaging of Genitourinary Sarcoidosis
Ali Nawaz Khan, Shyam Sunder Koteyar, Anthony Kodzo-Grey Venyo, and Ayan Sabih (Consultant Radiologist/Professor Honorary North Manchester General Hospital, UK, and others)

Chapter 7. Cardiac Sarcoidosis
Prabhakar Rajiah (Cardiothoracic Imaging Case Western Reserve University Hospitals of Cleveland, Cleveland, Ohio, USA)

Chapter 8. Imaging of Neurosarcoidosis
Rekha Siripurapu and Amit V Herwadkar (Department of Neuroradiology Greater Manchester Neurosciences Unit Salford Royal NHS Trust, Manchester, UK)

Chapter 9. Sarcoidosis of Spine: Clinical Profile & Imaging
Amit V Herwadkar and Rekha Siripurapu (Department of Neuroradiology Greater Manchester Neurosciences Unit Salford Royal NHS Trust, Manchester, UK)

Chapter 10. Radionuclides in the Diagnosis & Management of Sarcoidosis
Durr-e-Sabih, Ali Nawaz Khan and Ayan Sabih (Director, Multan Institute of Nuclear Medicine and Radiotherapy Multan – Pakistan, and others)

Chapter 11. The Role of PET/CT in Sarcoidosis
Ghulam Mustafa Shah Syed (Molecular Imaging Nuclear Medicine Section, Department of Medical Imaging, King Fahad National Guard Hospital, King A Aziz Medical City, Riyadh, Kingdom of Saudi Arabia)

Chapter 12. Ocular Manifestations of Sarcoidosis: Presentation, Diagnosis, Findings, and Treatment
Ali Afzal Bodla (Bodla Eye Care, Multan, Pakistan, Assistant Professor of Ophthalmology, Multan Medical and Dental College, Multan, Pakistan)


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