Spontaneous pneumothorax secondary to sarcoidosis

Case contributed by Dr Elias Bajotto Adaime

Presentation

Sudden dyspnea and chest pain. Non-smoking.

Patient Data

Age: 40
Gender: Male

Large right pneumothorax.

Lung parenchyma changes include multiple centrolobular and peribronchovascular micronodules diffusely distributed, with upper lobe predominance. Small cystic lesions, bronchiectasis and interlobular septal thickening are also noticed.

Mediastinal and hilar enlarged lymph nodes with extensive calcifications.

X-ray

Post-drainage chest x-ray

Chest x-ray 17 days after right thoracic drainage and pleurodesis show diffuse reticulonodular pattern with upper lobe predominance and bilateral hilar enlargement (stage II on chest radiograph).

Small residual subcutaneous emphysema is noticed in right side.

Pneumothorax is no longer observed.

The patient underwent thoracic drainage and pleurodesis, with pneumothorax resolution. Pleural biopsy was performed.

Histology:

Cronic granulomatous inflammation, sarcoid type, with extensive fibrosis. Compatible with sarcoidosis.

Case Discussion

This case shows a possible complication of sarcoidosis affecting the lung and pleura, as well as some typical image findings, such as:

  • perilymphatic nodules
  • lymphadenopathy: bilateral hilar, paratracheal, aortopulmonary window, subcarinal lymph nodes
  • lymph node calcification in chronic disease
  • mild cystic changes, possibly associated with incipient pulmonary fibrosis

Rupture of subpleural bullae or necrosis of subpleural granulomas are recognised causes of pneumothorax in sarcoidosis, occurring in only 2% of patients. Recurrence is possible, with some authors suggesting this as a manifestation of advanced disease.

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Case information

rID: 52035
Case created: 18th Mar 2017
Last edited: 7th Dec 2017
System: Chest
Inclusion in quiz mode: Included

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