Clinical Misdiagnosis of Pulmonary Sarcoidosis

XIE Yun; REN Mao

doi:10.3969/j.issn.1002-3429.2023.12.003

Abstract：Objective To explore the causes of misdiagnosis of pulmonary sarcoidosis and the measures to prevent misdiagnosis.Methods The clinical data of 9 patients with misdiagnosed pulmonary sarcoidosis admitted from January to De-cember 2021 were retrospectively analyzed.Results Two patients were initially diagnosed as mediastinal lymphoma due to painless enlargement of superficial lymph nodes,low fever,loss of appetite,nausea,night sweats,loss of body mass,skin pruritus,shortness of breath,elevated white blood cell count and neutrophil count,and chest imaging examination indicating enlargement of hilar and mediastinal lymph nodes.Due to fatigue,night sweats,loss of appetite,low fever,cough,blood in sputum in 1 case,chest tightness and shortness of breath in 1 case,increased red blood cell sedimentation rate,weak-positive reaction of purified protein derivative(PPD)test,and chest imaging examination that showed the double lung fiber cord like high-density shadow,preliminary diagnosis was primary pulmonary tuberculosis.Four patients presented with irritant dry cough,hoarseness,shortness of breath,low fever,chest pain,and hemoptysis.Chest imaging examination indicated enlarge-ment of hilar and mediastinal lymph nodes,and the preliminary diagnosis was central lung cancer.Superficial lymph node bi-opsy was performed in 2 patients,and CT-guided puncture biopsy was performed in 7 patients.The duration of misdiagnosis was 2-5 months.All the 9 patients were treated with Prednisone Acetate after diagnosis,for a total course of treatment for 1 year.The lung lesions were obviously absorbed,the clinical symptoms were obviously improved,and no recurrence was found at 6 months after follow-up.Conclusion Pulmonary sarcoidosis has no specific manifestations in its early stage,and its ima-ging manifestations are mainly symmetrical enlargement of both pulmonary hilar and mediastinal lymph nodes,which is more likely to be misdiagnosed as lung cancer,mediastinal lymphoma,tuberculosis and other lung diseases.Understanding the clinical and imaging manifestations of the disease,raising vigilance,carefully differentiating diagnosis,and performing CT-guided lung puncture biopsy,fibrobronchoscopic mucosal biopsy and superficial enlarged lymph node biopsy as soon as possible are beneficial to improving the diagnosis rate of the disease.