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Have Dry Cough, Redness Of Eye. Chest X-ray Showed Sarcoidosis Of The Lungs. Will It Affect Kidney?
Question: hi sir i did my mbbs and now i am doing residency in medicine.i am here to disscuss about my cousin.
he had dry cough and redness of eyes for 5 monnths.pulmonologist and eye doctor checked him.they made a diagnosis of sarcoidosis.
LAB RESULTS.
ACE 162
RADIOLOGIST after doing chest x XXXXXXX and high resolution ct scan gave the same opinion SARCOIDOSIS
his skin test for TB was negative no tuberculosis.
pulmonologist wanna do lung biopsy and biopsy of paratracheal and coronal lymph node in the chest.
one pulmonolgist opinion is that patient needs to have a ct scan with contrast to locate the lymh nodes and other vessels.
2nd pulmologist says ENDOTRACHEAL/ENDOBRONCHIAL ULTRASOUND GUIDED LYMPH NODE BIOPSY CAN BE DONE.LYMH NODES AND BLOOD VESSESLS CAN BE EASILLY LOCATED AND DIFFERENTIAD BY THE ENDOTRACHEAL ULTRASOUND AND LYMPH NODE BIOPSY CAN BE DONE SAFELY. THERE IS NO NEED OF CT SCAN WITH CONTRAST.
PATIENT DOES WANNA HAVE CT WITH CONTRAST BECAUSE SARCOIDOSIS CAN ALSO AFFECT KIDNEYS SO HE DOES NOT WANNA TAKE ANY RISK
WHAT IS YOUR OPINION?
he had dry cough and redness of eyes for 5 monnths.pulmonologist and eye doctor checked him.they made a diagnosis of sarcoidosis.
LAB RESULTS.
ACE 162
RADIOLOGIST after doing chest x XXXXXXX and high resolution ct scan gave the same opinion SARCOIDOSIS
his skin test for TB was negative no tuberculosis.
pulmonologist wanna do lung biopsy and biopsy of paratracheal and coronal lymph node in the chest.
one pulmonolgist opinion is that patient needs to have a ct scan with contrast to locate the lymh nodes and other vessels.
2nd pulmologist says ENDOTRACHEAL/ENDOBRONCHIAL ULTRASOUND GUIDED LYMPH NODE BIOPSY CAN BE DONE.LYMH NODES AND BLOOD VESSESLS CAN BE EASILLY LOCATED AND DIFFERENTIAD BY THE ENDOTRACHEAL ULTRASOUND AND LYMPH NODE BIOPSY CAN BE DONE SAFELY. THERE IS NO NEED OF CT SCAN WITH CONTRAST.
PATIENT DOES WANNA HAVE CT WITH CONTRAST BECAUSE SARCOIDOSIS CAN ALSO AFFECT KIDNEYS SO HE DOES NOT WANNA TAKE ANY RISK
WHAT IS YOUR OPINION?
Hi,
Thanks for posting the query on XXXXXXX After going through your query, I would like to comment the following:
1. The clinico radiological features are definitely favouring Sarcoidosis. Mantoux testing is done to exclude Sarcoid and not for TB. A mantoux positive result virtually rule out Sarcoidosis on acount of tuberculin anergy found on sarcoidosis.
2. A histopath report is required for confirmation of sarcoidosis. Non caseating granulomas need to be demonstrated.
3. Since already a HRCT Thorax is done, based on that an EBUS (Endo bronchial ultra sound ) if available should be the preferred option. Central lesions are best approached via bronchoscopy and peripheral lesions are best approached via CT.
4. Hence EBUS guided lymph node biopsy from the mediastinal/ paratracheal lymph nodes should be the preferred option.
I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Thanks for posting the query on XXXXXXX After going through your query, I would like to comment the following:
1. The clinico radiological features are definitely favouring Sarcoidosis. Mantoux testing is done to exclude Sarcoid and not for TB. A mantoux positive result virtually rule out Sarcoidosis on acount of tuberculin anergy found on sarcoidosis.
2. A histopath report is required for confirmation of sarcoidosis. Non caseating granulomas need to be demonstrated.
3. Since already a HRCT Thorax is done, based on that an EBUS (Endo bronchial ultra sound ) if available should be the preferred option. Central lesions are best approached via bronchoscopy and peripheral lesions are best approached via CT.
4. Hence EBUS guided lymph node biopsy from the mediastinal/ paratracheal lymph nodes should be the preferred option.
I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks for your answer....
HRCT scan is already done....
I KNOW MEDIASTINAL/PARATRACHEAL LYMPH NODES CAN BE LOCATED AND DIFFERENTIATED FROM NEAR BY BLOOD VESSELS AND BLOOD VESSELS CAN BE EASILLY SEEN ON EBUS OR ENDOTRACHEAL ULTRASOUND.
MY QUESTION IS THAT
IS THERE ANY NEED OF CT SCAN WITH COTRAST TO LOCATE MEDIASTINAL/PARATRACEAL LYMPH NODES AND DIFFERENTIATE LYMPH NODES FROM NEARBY BLOOD VESSELES?
HRCT scan is already done....
I KNOW MEDIASTINAL/PARATRACHEAL LYMPH NODES CAN BE LOCATED AND DIFFERENTIATED FROM NEAR BY BLOOD VESSELS AND BLOOD VESSELS CAN BE EASILLY SEEN ON EBUS OR ENDOTRACHEAL ULTRASOUND.
MY QUESTION IS THAT
IS THERE ANY NEED OF CT SCAN WITH COTRAST TO LOCATE MEDIASTINAL/PARATRACEAL LYMPH NODES AND DIFFERENTIATE LYMPH NODES FROM NEARBY BLOOD VESSELES?
Hi,
Thanks for the follow up.
Ideally always a plain and contrast ct scan are done in the same setting. In plain CT due to the absence of contrast filling it is sometimes difficult to localise the lymph nodes. However EBUS can also detect paratracheal/mediastinal lymph nodes and FNAC can be done in the same setting. Hence instead of going for a contrast ct an EBUS if available should be a good option.
I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Thanks for the follow up.
Ideally always a plain and contrast ct scan are done in the same setting. In plain CT due to the absence of contrast filling it is sometimes difficult to localise the lymph nodes. However EBUS can also detect paratracheal/mediastinal lymph nodes and FNAC can be done in the same setting. Hence instead of going for a contrast ct an EBUS if available should be a good option.
I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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