Abstract
Purpose :
Radiographic chest imaging is an important part of the evaluation of patients with uveitis to diagnose presumed sarcoidosis, an idiopathic systemic granulomatous inflammation. Sarcoidosis accounts for approximately 10% of uveitis; 12-30% of patients with sarcoidosis initially present with uveitis and 10-70% eventually develop uveitis. The prevalence of sarcoidosis and uveitis varies widely with geography and ethnicity. We studied the value of chest X-ray in the evaluation of uveitis patients in the Western United States.
Methods :
Charts from 566 uveitis patients were reviewed. 199 chest X-rays were performed in patients with an unknown uveitic diagnosis. Age, race, and anatomic location of the uveitis were analyzed. Presumed sarcoidosis was defined as the presence of bilateral hilar lymphadenopathy in a patient with uveitis. Additional uveitis patients with previously diagnosed sarcoidosis were also identified during the chart review.
Results :
Of the 199 patients with unknown uveitic diagnoses 51.5% had anterior uveitis, 19.7% had intermediate uveitis, 11.6% had posterior uveitis and 17.2% had panuveitis. Five chest X-rays showed bilateral hilar lymphadenopathy consistent with presumed sarcoidosis, a discovery rate of 2.5%. Three of these five patients had anterior uveitis and two had intermediate uveitis. Four of the five patients were African American and one was Caucasian. In the group of 566 patients, there were 26 additional patients with known sarcoidosis, yielding a 5.48% prevalence of sarcoid uveitis. Of the 31 patients with uveitis and sarcoidosis, 58% were African American despite African Americans comprising only 15.7% of the total 566 patients. The relative risk of bilateral hilar lymphadenopathy for an African American in the 199 imaged patients was 11.2.
Conclusions :
Chest X-ray screening for sarcoid uveitis has a low yield in our population, and is most likely to be positive in African Americans. The prevalence of sarcoidosis and hence the utility of chest X-ray as a screening tool for presumed sarcoidosis varies according to geographic region. Although the chest CT scan is more sensitive than chest X-ray, the cost and radiation dose are greater and this may not be indicated in low incidence populations. The prevalence of presumed sarcoid uveitis in our study is lower than other studies, but not dissimilar from the findings in similar ethnic populations.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.