Asai Y, Nakayama T, Furuichi S, Kobayashi T, Hashimoto S, Horie T
First Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchikamimachi, Itabashi-ku, Tokyo 172, Japan.
Nihon Kokyuki Gakkai Zasshi. 2000 Dec;38(12):952-7.
Sarcoidosis has a variety of pulmonary manifestations including the nodular, or infiltrative form. However, primary cavitary formation is rare. In this report, we describe three cases of sarcoidosis with primary acute pulmonary cavitations. All three patients were young adults (2 men and 1 woman) and chest radiography and chest CT showed bilateral Hilary lymphadenopathy, multiple cavitations with thin, smooth walls, and diffuse granular shadows. Primary acute pulmonary cavitation of sarcoidosis was diagnosed, since a transbronchial biopsy specimen revealed sarcoid granuloma, and there was no evidence of infection, emphysematous change, or fibrotic or cystic bronchiectatic changes on chest radiography in any case. Corticosteroid therapy was given in all cases for severe extrathoracic disease (2 of severe uveitis and 1 of CNS involvement). After the treatment, the multiple cavities and diffuse granular shadows in the lung fields disappeared. We accordingly suggest that corticosteroid therapy is effective for primary acute cavitation in sarcoidosis.
结节病有多种肺部表现，包括结节状或浸润性形式。然而，原发性空洞形成很少见。在本报告中，我们描述了3例原发性急性肺空洞的结节病病例。所有3例患者均为年轻成年人（2名男性和1名女性），胸部X线和胸部CT显示双侧肺门淋巴结肿大、多个薄壁光滑的空洞以及弥漫性颗粒状阴影。由于经支气管活检标本显示结节病肉芽肿，且在任何病例的胸部X线检查中均无感染、肺气肿改变、纤维化或囊性支气管扩张改变的证据，因此诊断为结节病原发性急性肺空洞。所有病例均因严重的胸外疾病（2例严重葡萄膜炎和1例中枢神经系统受累）接受了皮质类固醇治疗。治疗后，肺野中的多个空洞和弥漫性颗粒状阴影消失。因此，我们认为皮质类固醇治疗对结节病原发性急性空洞有效。
