PLEURAL INVOLVEMENT IN SARCOIDOSIS - CASE PRESENTATION AND DETAILED REVIEW OF THE LITERATURE

Sarcoidosis has been reported to involve the pleura uncommonly. At least some of the paucity of reports is related to previous methods of detection. It is still too early to determine if conventional or high resolution CT scanning will demonstrate a markedly increased prevalence of sarcoid pleural involvement. Sarcoid involvement of the pleura may take the form of effusion (acute or chronic), thickening, pneumothorax, hemothorax, chylothorax, or hydropneumothorax. Noncaseating granulomas may or may not always be found on biopsy. Because of the chronic nature of the disease and the frequent latency in detecting pleural involvement, biopsy confirmation is not required to diagnose sarcoidosis if the disease is proven elsewhere and if fungal and mycobacterial disease of the pleura have been eliminated from consideration. A possible sequence of workup of sarcoid pleural effusion would therefore begin with confirming the presence of sarcoidosis (i.e. noncaseating granulomas typical for sarcoidosis) in some organ by biopsy. In the process of doing this, the fluid needs to be characterized (mainly to rule out nonsarcoid disease). Included in this evaluation is a pleural biopsy that is very sensitive for mycobacterial disease. If nonspecific pleural biopsy findings are reported and noncaseating granulomas are found elsewhere in the body and if mycobacterial, fungal, and neoplastic disease can be eliminated from the differential diagnosis by cultures and special stains, a diagnosis of pleural sarcoidosis still can be made with reasonable certainty.