Brillet P-Y, Nunes H, Soussan M, Brauner M-W
Service de radiologie, hôpital Avicenne, 125 route de Stalingrad, Bobigny cedex, France.
Rev Pneumol Clin. 2011 Apr;67(2):94-100. doi: 10.1016/j.pneumo.2010.06.003. Epub 2010 Dec 3.
Sarcoidosis is a juvenile systemic granulomatosis. Its polymorphic clinical presentation depends on its different localisations, thoracic and extrathoracic. The role of imaging is very important for all localisations; but for mediastinopulmonary involvement, which is the most frequent (>90% of cases), it plays a major role in detecting the disease, diagnosing it, its prognosis, decision-making regarding treatment of it and in the monitoring of its development. Standard radiography, which sometimes detects the disease, forms the basis for its four-stage prognostic classification. CT scanning enables the study of mediastinal and hilar lymphadenopathy and the study of parenchyma, making it possible to identify micronodules of lymphatic distributions, alveolar opacities, septal lines, ground-glass hyperintensities, nodules surrounded by a ring of satellite micronodules, peribronchovascular thickening; all potentially reversible lesions. Elsewhere, it highlights irreversible fibrous lesions: hilar peripheral linear opacities; septal linear opacities; bronchial distortion, honeycomb destruction or even perihilar fibrotic masses. Less frequently we can visualise bronchiolar or cystic involvement. Benign in most cases, the sarcoidosis prognosis becomes bleaker in the event of hemoptysis, Aspergillus colonisation or before the onset of pulmonary hypertension.
结节病是一种青少年系统性肉芽肿病。其多形性临床表现取决于不同的部位，包括胸部和胸外部位。影像学检查对所有部位都非常重要；但对于最常见的纵隔肺受累（>90%的病例），它在疾病的检测、诊断、预后评估、治疗决策以及病情发展监测中发挥着重要作用。标准X线摄影有时能检测到该病，是其四级预后分类的基础。CT扫描能够研究纵隔和肺门淋巴结肿大以及实质情况，从而有可能识别淋巴分布的微结节、肺泡实变、间隔线、磨玻璃样高密度影、被卫星微结节环包围的结节、支气管血管周围增厚；所有这些都是潜在的可逆性病变。在其他部位，它能凸显不可逆的纤维性病变：肺门周围线性实变；间隔线性实变；支气管扭曲、蜂窝状破坏甚至肺门周围纤维化肿块。较少见的情况下，我们可以看到细支气管或囊性受累。结节病在大多数情况下是良性的，但如果出现咯血、曲霉菌定植或在肺动脉高压发作前，其预后会变差。
