Vocal cord paralysis as the presenting symptom of sarcoidosis (original) (raw)

A 71-yr-old male with increasing dyspnoea, cough and an intrathoracic mass

European Respiratory Journal, 2003

A 71-year-old White male was referred to the Martini Hospital for evaluation of progressive shortness of breath, tiredness, a nonproductive cough and night sweats. Until the beginning of his complaints a few weeks before, he felt healthy and skated 40 km per week. His appetite was good, he had not lost weight, had no skin or joint disorders and no thoracic pain.

Pulmonary sarcoidosis presenting as hoarseness and mass lesion

Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace, 2021

A 46-year male, ex-smoker presented with cough and hoarseness for 2-3 months. The CECT chest revealed a left upper lobe mass. BAL was negative for AFB, GeneXpert, and malignant cells. The bronchial biopsy showed granuloma with no caseation and infiltration of lymphoid cells. The ultrasound abdomen was normal. The patient was started on prednisolone 0.5 mg/kg. He improved clinic-radiologically. Ex-smoker, middle-aged man with hoarseness and mass lesion on CECT chest is highly suspicious of lung malignancy. Pulmonary sarcoidosis should be kept in the differential diagnosis of unexplained hoarseness and mass lesion as the disease has diverse presentations.

Clinical Manifestations of Sarcoidosis

Sarcoidosis, 2013

Type of involvement Comments Mucosal erythema and edema Nonspecific finding* Granular mucosa Nonspecific* Cobblestone mucosa More common in lobar and segmental bronchi* Mucosal plaques (yellowish) Also occurs in other disorders* Paralysis of the left vocal cord and hoarseness can occur from compression of the left recurrent laryngeal nerve by enlarged lymph nodes [24, 25]. Systemic corticosteroid therapy has resulted in resolution of the hoarseness [24]. 2.3. Central airways The trachea and main bronchi are less frequently affected than the lobar, segmental, subsegmental, and distal airways. Sarcoid granulomas of trachea, main carina, and major bronchi by themselves seldom produce significant obstructive symptoms or airway dysfunction [26, 27]. Cough is the main symptom. Symptoms, clinical examination, flow-volume curves, and bronchoscopy help in assessing the severity of the central airway stenosis [28]. Mainstem bronchial stenoses as well as segmental stenosis have been described in patients with sarcoidosis [29]. Disabling inspiratory and expiratory airflow limitation mimicking fixed upper airway obstruction has been reported [27]. Bronchoscopy may demonstrate other changes as: mucosal erythema, edema, friability, granularity, fine cobblestoning, and sarcoid nodules. The characteristic yellow waxy nodules typical of sarcoidosis are less likely to occur in the trachea and main bronchi, but when seen in these areas, they tend to be sparsely distributed. Extrinsic compression of the central airways by the enlarged mediastinal and hilar lymph nodes is uncommon. Right middle lobe syndrome caused by extrinsic compression and intraluminal sarcoidosis has been described [30]. 2.4. Distal airways Sarcoidosis could affect lobar, segmental, subsegmental, and more distal bronchi as well as bronchioles, which is manifested as mucosal inflammation, endobronchial granulomas, stenosis, extrinsic compression, distortion, bronchiectasis, bronchiolitis, airway hyperreactivity, and streaky hemoptysis.

Intrathoracic sarcoidosis : atypical radiological forms found in clinical practice – GUTEANU

2017

La sarcoïdose est une maladie granulomateuse systémique à localisation médiastino-pulmonaire prédominante. Elle est asymptomatique ou prend souvent des signes généraux: fatigue, sueurs nocturnes, toux, dyspnée. Elle est dite atypique lorsque certaines présentations clinique, radiologique ou évolutive de l’atteinte médiastino-pulmonaire ou des localisations extrathoraciques sont atypiques. L’aspect radiologique atypique montre des images de l’atteinte miliaire parenchymateuse, des opacités alvéolaires bilatérales excavées (nécrobiose au sein de zones confluentes granulomateuses), des adénopathies médiastinales calcifiées, atteinte unilatérale, ganglionnaire ou parenchymateuse, atteinte pleurale (épaississements pleuraux ou pleurésie) ou formes ganglionnaire médiastinale et parenchymateuse d’un aspect pseudotumoral. La sténose d’allure tumorale est la forme atypique observée après l’endoscopie bronchique. On rappelle quelques aspects inhabituels de la sarcoïdose (miliaire parenchymate...