Perry A, Vuitch F
Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235-9072.
Arch Pathol Lab Med. 1995 Feb;119(2):167-72.
To evaluate the contribution of sarcoidosis to death, we reviewed 38 autopsy cases. The diagnosis of sarcoidosis was established or suspected antemortem in 17 (45%) of 38 cases. Sarcoid was fatal in 67% and incidental in 33%. Of 28 fatal cases, 14 (50%) resulted from cardiac involvement and 12 (43%) from pulmonary disease. Antemortem diagnosis was made in 4 (29%) of 14 fatal cardiac cases versus 9 (75%) of 12 fatal pulmonary cases. This study reveals that antemortem diagnosis of sarcoidosis is challenging and that heart and lung involvement are the most significant contributors to fatal outcome. Cardiac sarcoidosis is frequently first diagnosed postmortem and is a more common cause of death than previously reported. Unlike previous studies, we found that fatal cardiac sarcoidosis is commonly associated with significant extracardiac disease, implying that antemortem diagnosis may be suspected without endomyocardial biopsy in most patients.
为评估结节病对死亡的影响，我们回顾了38例尸检病例。38例病例中有17例（45%）在生前确诊或疑似结节病。结节病致死的占67%，偶然发现的占33%。在28例致死病例中，14例（50%）因心脏受累致死，12例（43%）因肺部疾病致死。14例致死性心脏病例中有4例（29%）生前确诊，而12例致死性肺部病例中有9例（75%）生前确诊。本研究表明，结节病的生前诊断具有挑战性，心脏和肺部受累是导致致命后果的最重要因素。心脏结节病常于死后首次诊断，且是比此前报道更常见的死亡原因。与以往研究不同，我们发现致命性心脏结节病通常与显著的心脏外疾病相关，这意味着在大多数患者中，即使没有心内膜心肌活检，也可能怀疑生前诊断。
