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Careen Y. Lowder, Nithya Iyer, Daniel A. Culver; Computed Tomographic And Chest Radiographic Findings In Patients With Ocular Sarcoidosis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5479.
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Ocular involvement as the first manifestation of systemic sarcoidosis is infrequent, although the eyes are involved in 10-50% of sarcoidosis subjects at some point in the disease. Since the diagnosis of sarcoidosis requires tissue biopsy, patients presenting with ocular symptoms are frequently referred to the pulmonologist for a systemic survey and bronchoscopy. In this study, we describe the yield of chest radiograph (CXR) and computed tomography (CT) of the chest in patients presenting primarily with ocular symptoms.
We performed a retrospective chart review of all patients referred to the pulmonary clinic from the department of ophthalmology between 2002-2009 with a suspicion of ocular sarcoidosis. Data with regard to patient demographics, CT chest findings, and pathology reports were collected.
60 patients (18 male, 42 female) were identified, 41 of whom had a CXR. CXR findings typical of sarcoidosis (bilateral mediastinal adenopathy and/or bilateral nodular infiltrates) were identified in 10 of these patients. Out of these 10 patients, 9 had a histological diagnosis of sarcoidosis (defined as the presence of non-necrotising granulomas with negative cultures) and 1 did not have a biopsy. Among the patients with a negative CXR (31 patients) 13 had negative biopsies, 7 had positive biopsies and 11 patients did not have a biopsy performed. CXR was thus found to have a sensitivity of 56% and specificity of 100% for the diagnosis of pulmonary sarcoidosis. CT chest was obtained in 58 patients. We classified the findings on CT as typical (bilateral adenopathy and/or peribronchovascular nodules), atypical (abnormal findings but not typical for sarcoidosis) or normal. These findings were correlated with the biopsy results: CT chest typical, no biopsy (4), biopsy positive 20 (86.9%), biopsy negative 3 (13.1%); CT chest atypical, no biopsy (6), biopsy positive 4 (25%), biopsy negative 12 (75%), CT chest normal, no biopsy (7), biopsy positive 0 (0%), biopsy negative 2 (100%). Additionally, 11 patients with a normal CXR were noted to have typical features of sarcoidosis on CT chest. 6 patients in this group (75%) had a positive biopsy and 2 (25%) had a negative biopsy (3 did not have a biopsy done).
In patients presenting with ocular symptoms, both CXR and CT chest appear to be highly specific in the diagnosis of sarcoidosis, when typical radiographic features are present. However, the presence of atypical features on CT chest does not exclude the diagnosis, and in the right clinical setting the possibility of sarcoidosis should still be entertained.
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