Hattori Takeshi, Konno Satoshi, Inomata Takashi, Nasuhara Yasuyuki, Betsuyaku Tomoko, Nishimura Masaharu
First Department of Medicine, Hokkaido University School of Medicine.
Nihon Kokyuki Gakkai Zasshi. 2009 Jul;47(7):658-62.
Pleural sarcoidosis is not a rare disease, and some patients with sarcoidosis experience chest pain, although the cause is often unknown. Various studies have indicated that fluorodeoxyglucose-positron emission tomography (FDG-PET) is useful for diagnosing and monitoring sarcoidosis.
A 62-year-old man noted left-side dominant chest and back pain, although chest computed tomography (CT) revealed no abnormalities. Two months later, chest and back pain rapidly increased in severity and blurred vision appeared. In addition to uveitis, renal dysfunction was observed and chest CT on admission revealed enlargement of bilateral hilar/mediastinal lymph nodes and diffuse small nodular opacities and subpleural nodules, mainly in the segment of the left upper lobe (S1+2). FDG-PET revealed intense FDG uptake in bilateral peripheral lung parenchyma, spread widely along the subpleura and right inguinal lymph nodes with high uptake in the hilar and mediastinal lymph nodes. Sarcoidosis was diagnosed by transbronchial lung biopsy and renal biopsy. Oral corticosteroid treatment was performed due to persistent chest and back pain and rapid progression of renal dysfunction. Chest and back pain immediately disappeared and renal function improved. Follow-up FDG-PET performed 2 months after corticosteroid treatment revealed no areas of intense FDG uptake.
胸膜结节病并非罕见疾病，一些结节病患者会出现胸痛，尽管其病因通常不明。多项研究表明，氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）对结节病的诊断和监测有用。
一名62岁男性出现以左侧为主的胸部和背部疼痛，尽管胸部计算机断层扫描（CT）未显示异常。两个月后，胸部和背部疼痛的严重程度迅速加重，并出现视力模糊。除葡萄膜炎外，还观察到肾功能障碍，入院时胸部CT显示双侧肺门/纵隔淋巴结肿大，以及弥漫性小结节状阴影和胸膜下结节，主要位于左上叶（S1+2）段。FDG-PET显示双侧外周肺实质有强烈的FDG摄取，沿胸膜下广泛扩散至右腹股沟淋巴结，肺门和纵隔淋巴结摄取较高。经支气管肺活检和肾活检确诊为结节病。由于持续的胸部和背部疼痛以及肾功能的快速进展，进行了口服皮质类固醇治疗。胸部和背部疼痛立即消失，肾功能改善。皮质类固醇治疗2个月后进行的随访FDG-PET显示没有FDG摄取强烈的区域。
