Sarcoidosis physical examination
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: : Roshan Dinparasti Saleh M.D.
Overview
Nearly half of the patients with sarcoidosis are diagnosed incidentally with a chest radiograph but the disease clinical picture can range from normal to severe organ failure.
Physical examination
In half of the patients diagnosed with sarcoidosis, the disease is found incidentally by a CXR (bilateral hilar lymphadenopathy, reticular opacities) before the symptoms develop. Lung is the most common organ involved by sarcoidosis, but up to 30% percent of patients present with extra-pulmonary manifestations of sarcoidosis. The most common pattern of lung involvement in sarcoidosis is interstitial lung disease (other less common pulmonary manifestations include pneumothorax, pleural thickening, chylothorax, pulmonary hypertension)[1][2][3].
- Crackles are not commonly auscultated on lung examination. Wheezing may be heard when there is endobronchial involvement.
- In 8 to 15 year-old children, the disease presentation is similar to adults but younger children present with skin rash, arthritis, and red eye(uveitis). 90% of the children have an abnormal CXR[4][5][6].
Common types of skin involvement in sarcoidosis are:
- Papular sarcoidosis: usually involves lips, forehead, eyelids, neck, previous trauma sites, and alae nares.
- Nodular sarcoidosis: usually involves trunk and extensor surface of the arms and legs.
- Plaque-like sarcoidosis: commonly involves shoulders, arms, and back.
- Lupus pernio: purple or red indurated papules/plaques/nodules that commonly involves nose, cheeks, chin, and ears.
- Erythema nodosum: painful nodular lesions commonly involving anterior surface of lower extremities and is associated with good prognosis. Biopsy from erythema nodosum usually is not helpful.
- Subcutaneous sarcoidosis: resembles erythema nodosum but usually on upper extremities, and asymptomatic[7][8][9][10].
Ocular manifestations of sarcoidosis can be classified as anterior, intermediate, and posterior uveitis[11].
- Mutton-fat keratic precipitates : a sign of anterior uveitis
- Granulomatous keratic precipitates: a sign of anterior uveitis
- Koeppe Busacca: a sign of anterior uveitis
- Trabecular meshwork nodules: seen in anterior uveitis
- Peripheral anterior synechiae: seen in anterior uveitis
- Vitrous opacities: as snowballs/strings of pearls are seen in intermediate uveitis known as pars planitis.
- Chorioretinal peripheral lesions
- Nodular and segmental periphlebitis with or without candle wax drippings: signs of posterior uveitis
- Optic disc nodule
- Choroidal nodule
- Heerfordt’s syndrome(uveoparotid fever): anterior uveitis, parotid gland enlargement, facial nerve palsy, and fever[12][13][14]
involvement of extra-ocular orbital tissues by sarcoidosis can be seen as palpable mass, orbital swelling, conjunctival granulomas, lacrimal gland involvement, and extra-ocular muscles involvement[15]
Cardiovascular Sarcoidosis
Cardiovascular involvement by sarcoidosis can range from heart block and arrhythmias to heart failure, valvular dysfuntion, pericardial disease, pulmonary hypertension and sudden cardiac death[16]
Reticuloendothelial System
- Peripheral lymphadenopathy is seen in 40% of patients.
- Hepatomegaly is seen in 20% of hepatic sarcoid patients.
- Splenomegaly is seen in 6% of patients diagnosed with sarcoidosis[17][18][19].
- Acute polyarthritis, especially symmetric involvement of the ankle joints presented as joint swelling, redness and tenderness[20]
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Gallery
Skin
Head
Neck
Extremities
References
- ↑ Ungprasert P, Carmona EM, Utz JP, Ryu JH, Crowson CS, Matteson EL: Epidemiology of Sarcoidosis 1946-2013: A Population-Based Study. Mayo Clinic proceedings 2016, 91(2):183-188.
- ↑ Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Jr., Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ et al: Clinical characteristics of patients in a case control study of sarcoidosis. American journal of respiratory and critical care medicine 2001, 164(10 Pt 1):1885-1889.
- ↑ Rizzato G, Tinelli C: Unusual presentation of sarcoidosis. Respiration; international review of thoracic diseases 2005, 72(1):3-6.
- ↑ Nathan N, Marcelo P, Houdouin V, Epaud R, de Blic J, Valeyre D, Houzel A, Busson PF, Corvol H, Deschildre A et al: Lung sarcoidosis in children: update on disease expression and management. Thorax 2015, 70(6):537-542.
- ↑ Pattishall EN, Kendig EL, Jr.: Sarcoidosis in children. Pediatric pulmonology 1996, 22(3):195-203.
- ↑ Milman N, Hoffmann AL: Childhood sarcoidosis: long-term follow-up. The European respiratory journal 2008, 31(3):592-598.
- ↑ Mana J, Marcoval J, Graells J, Salazar A, Peyri J, Pujol R: Cutaneous involvement in sarcoidosis. Relationship to systemic disease. Archives of dermatology 1997, 133(7):882-888.
- ↑ Mangas C, Fernandez-Figueras MT, Fite E, Fernandez-Chico N, Sabat M, Ferrandiz C: Clinical spectrum and histological analysis of 32 cases of specific cutaneous sarcoidosis. Journal of cutaneous pathology 2006, 33(12):772-777.
- ↑ Elgart ML: Cutaneous sarcoidosis: definitions and types of lesions. Clinics in dermatology 1986, 4(4):35-45.
- ↑ Krasowska D, Schwartz RA, Wojnowska D, Mackiewicz B, Czelej D: Polymorphous cutaneous and chronic multisystem sarcoidosis. Acta dermatovenerologica Alpina, Pannonica, et Adriatica 2008, 17(1):26-30.
- ↑ Evans M, Sharma O, LaBree L, Smith RE, Rao NA: Differences in clinical findings between Caucasians and African Americans with biopsy-proven sarcoidosis. Ophthalmology 2007, 114(2):325-333.
- ↑ Herbort CP, Rao NA, Mochizuki M: International criteria for the diagnosis of ocular sarcoidosis: results of the first International Workshop On Ocular Sarcoidosis (IWOS). Ocular immunology and inflammation 2009, 17(3):160-169.
- ↑ James DG, Sharma OP: Parotid gland sarcoidosis. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG 2000, 17(1):27-32.
- ↑ Petropoulos IK, Zuber JP, Guex-Crosier Y: Heerfordt syndrome with unilateral facial nerve palsy: a rare presentation of sarcoidosis. Klinische Monatsblatter fur Augenheilkunde 2008, 225(5):453-456.
- ↑ Mavrikakis I, Rootman J: Diverse clinical presentations of orbital sarcoid. American journal of ophthalmology 2007, 144(5):769-775.
- ↑ Darlington P, Gabrielsen A, Sorensson P, Cederlund K, Eklund A, Grunewald J: Cardiac involvement in Caucasian patients with pulmonary sarcoidosis. Respiratory research 2014, 15:15.
- ↑ Vagal AS, Shipley R, Meyer CA: Radiological manifestations of sarcoidosis. Clinics in dermatology 2007, 25(3):312-325.
- ↑ Warshauer DM, Lee JK: Imaging manifestations of abdominal sarcoidosis. AJR American journal of roentgenology 2004, 182(1):15-28.
- ↑ Salazar A, Mana J, Corbella X, Albareda JM, Pujol R: Splenomegaly in sarcoidosis: a report of 16 cases. Sarcoidosis 1995, 12(2):131-134.
- ↑ Kellner H, Spathling S, Herzer P: Ultrasound findings in Lofgren’s syndrome: is ankle swelling caused by arthritis, tenosynovitis or periarthritis? The Journal of rheumatology 1992, 19(1):38-41.
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