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To exclude sarcoidosis in a case presenting with pulmonary symptoms might involve a chest radiograph, CT scan of chest, PET scan, CT-guided biopsy, mediastinoscopy, open lung biopsy, bronchoscopy with biopsy, endobronchial ultrasound, and endoscopic ultrasound with fine-needle aspiration of mediastinal lymph nodes (EBUS FNA).
Mediastinoscopy is a procedure that enables visualization of the contents of the mediastinum, usually for the purpose of obtaining a biopsy. [1] Mediastinoscopy is often used for staging of lymph nodes of lung cancer or for diagnosing other conditions affecting structures in the mediastinum such as sarcoidosis or lymphoma.
A lung biopsy is an interventional procedure performed to diagnose lung pathology by obtaining a small piece of lung which is examined under a microscope. [1] [2] Beyond microscopic examination for cellular morphology and architecture, special stains and cultures can be performed on the tissue obtained. [3]
CT scan, lung biopsy [3] Differential diagnosis: Sarcoidosis, other interstitial lung diseases, hypersensitivity pneumonitis [4] Treatment: Pulmonary rehabilitation, supplemental oxygen, lung transplantation [1] Medication: Pirfenidone, nintedanib [2] Prognosis: Life expectancy ~ 4 years [1] Frequency: 12 per 100,000 people per year [4]
Despite the medical advances of detection, diagnosis and treatment methods throughout the past 50 years, lung cancer causes more deaths than any other cancer in both men and women. [5] Currently, lung cancer is the most common form of cancer diagnosed in the United States and a major cause of death, accounting for 14% of all cancers. [6]
Pneumothorax occurs in less than 1% of lung biopsy cases. Laryngospasm is a rare complication but may sometimes require tracheal intubation. Patients with tumors or significant bleeding may experience increased difficulty breathing after a bronchoscopic procedure, sometimes due to swelling of the mucous membranes of the airways.
A lung biopsy may be required if the clinical history and imaging are not clearly suggestive of a specific diagnosis or malignancy cannot otherwise be ruled out. Surgical lung biopsy or via a video-assisted thoracoscopic surgery (VATS) biopsy is associated with a mortality rate up to 1-2%.
Exclusion of infection is therefore an important step in management, but confirmation of the diagnosis requires lung biopsy. In people who have lung disease prior to a diagnosis of CVID, the differential diagnosis includes sarcoidosis. Sarcoid is also characterised by granulomatous involvement of the lung and therefore patients being ...