Sarcoidosis physical examination: Difference between revisions
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* [[Erythema nodosum]]: painful nodular lesions commonly involving anterior surface of lower extremities and is associated with good prognosis. Biopsy from [[erythema nodosum]] usually is not helpful. | * [[Erythema nodosum]]: painful nodular lesions commonly involving anterior surface of lower extremities and is associated with good prognosis. Biopsy from [[erythema nodosum]] usually is not helpful. | ||
* [[Subcutaneous sarcoidosis]]: resembles [[erythema nodosum]] but usually on upper extremities, and asymptomatic<ref>Mana J, Marcoval J, Graells J, Salazar A, Peyri J, Pujol R: Cutaneous involvement in sarcoidosis. Relationship to systemic disease. Archives of dermatology 1997, 133(7):882-888.</ref><ref>Mangas C, Fernandez-Figueras MT, Fite E, Fernandez-Chico N, Sabat M, Ferrandiz C: Clinical spectrum and histological analysis of 32 cases of specific cutaneous sarcoidosis. Journal of cutaneous pathology 2006, 33(12):772-777.</ref><ref>Elgart ML: Cutaneous sarcoidosis: definitions and types of lesions. Clinics in dermatology 1986, 4(4):35-45.</ref><ref>Krasowska D, Schwartz RA, Wojnowska D, Mackiewicz B, Czelej D: Polymorphous cutaneous and chronic multisystem sarcoidosis. Acta dermatovenerologica Alpina, Pannonica, et Adriatica 2008, 17(1):26-30.</ref>. | * [[Subcutaneous sarcoidosis]]: resembles [[erythema nodosum]] but usually on upper extremities, and asymptomatic<ref>Mana J, Marcoval J, Graells J, Salazar A, Peyri J, Pujol R: Cutaneous involvement in sarcoidosis. Relationship to systemic disease. Archives of dermatology 1997, 133(7):882-888.</ref><ref>Mangas C, Fernandez-Figueras MT, Fite E, Fernandez-Chico N, Sabat M, Ferrandiz C: Clinical spectrum and histological analysis of 32 cases of specific cutaneous sarcoidosis. Journal of cutaneous pathology 2006, 33(12):772-777.</ref><ref>Elgart ML: Cutaneous sarcoidosis: definitions and types of lesions. Clinics in dermatology 1986, 4(4):35-45.</ref><ref>Krasowska D, Schwartz RA, Wojnowska D, Mackiewicz B, Czelej D: Polymorphous cutaneous and chronic multisystem sarcoidosis. Acta dermatovenerologica Alpina, Pannonica, et Adriatica 2008, 17(1):26-30.</ref>. | ||
===Ocular Sarcoidosis=== | |||
Ocular manifestations of [[sarcoidosis]] can be classified as anterior, intermediate, and posterior [[uveitis]]<ref>Evans M, Sharma O, LaBree L, Smith RE, Rao NA: Differences in clinical findings between Caucasians and African Americans with biopsy-proven sarcoidosis. Ophthalmology 2007, 114(2):325-333.</ref>. | |||
* [[Mutton-fat keratic precipitates]] : a sign of [[anterior uveitis]] | |||
* [[Granulomatous keratic precipitates]]: a sign of [[anterior uveitis]] | |||
* [[Koeppe Busacca]]: a sign of [[anterior uveitis]] | |||
* [[Trabecular meshwork nodules]]: seen in [[anterior uveitis]] | |||
* [[Peripheral anterior synechiae]]: seen in [[anterior uveitis]] | |||
* [[Vitrous opacities]]: as snowballs/strings of pearls are seen in [[intermediate uveitis]] known as [[pars planitis]]. | |||
* Chorioretinal peripheral lesions | |||
* Nodular and segmental [[periphlebitis]] with or without [[candle wax dripping]]s: signs of [[posterior uveitis]] | |||
* [[Optic disc nodule]] | |||
* [[Choroidal nodule]] | |||
* [[Heerfordt's syndrome]]([[uveoparotid fever]]): [[anterior uveitis]], [[parotid gland enlargement]], [[facial nerve palsy]], and [[fever]]<ref>Herbort CP, Rao NA, Mochizuki M: International criteria for the diagnosis of ocular sarcoidosis: results of the first International Workshop On Ocular Sarcoidosis (IWOS). Ocular immunology and inflammation 2009, 17(3):160-169.</ref><ref>James DG, Sharma OP: Parotid gland sarcoidosis. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG 2000, 17(1):27-32.</ref><ref>Petropoulos IK, Zuber JP, Guex-Crosier Y: Heerfordt syndrome with unilateral facial nerve palsy: a rare presentation of sarcoidosis. Klinische Monatsblatter fur Augenheilkunde 2008, 225(5):453-456.</ref> | |||
Revision as of 05:33, 28 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: : Roshan Dinparasti Saleh M.D.
Overview
Physical examination
Pulmonary Sarcoidosis
In half of the patients diagnosed with sarcoidosis, the disease is found incidentally by a CXR (bilateral hilar lymphadenopathy, reticular opacities) before the symptoms develop. Lung is the most common organ involved by sarcoidosis, but up to 30% percent of patients present with extra-pulmonary manifestations of sarcoidosis. The most common pattern of lung involvement in sarcoidosis is interstitial lung disease (other less common pulmonary manifestations include pneumothorax, pleural thickening, chylothorax, pulmonary hypertension)[1][2][3].
- Crackles are not commonly auscultated on lung examination. Wheezing may be heard when there is endobronchial involvement.
- In 8 to 15 year-old children, the disease presentation is similar to adults but younger children present with skin rash, arthritis, and red eye(uveitis). 90% of the children have an abnormal CXR[4][5][6].
Cutaneous Sarcoidosis
Common types of skin involvement in sarcoidosis are:
- Papular sarcoidosis: usually involves lips, forehead, eyelids, neck, previous trauma sites, and alae nares.
- Nodular sarcoidosis: usually involves trunk and extensor surface of the arms and legs.
- Plaque-like sarcoidosis: commonly involves shoulders, arms, and back.
- Lupus pernio: purple or red indurated papules/plaques/nodules that commonly involves nose, cheeks, chin, and ears.
- Erythema nodosum: painful nodular lesions commonly involving anterior surface of lower extremities and is associated with good prognosis. Biopsy from erythema nodosum usually is not helpful.
- Subcutaneous sarcoidosis: resembles erythema nodosum but usually on upper extremities, and asymptomatic[7][8][9][10].
Ocular Sarcoidosis
Ocular manifestations of sarcoidosis can be classified as anterior, intermediate, and posterior uveitis[11].
- Mutton-fat keratic precipitates : a sign of anterior uveitis
- Granulomatous keratic precipitates: a sign of anterior uveitis
- Koeppe Busacca: a sign of anterior uveitis
- Trabecular meshwork nodules: seen in anterior uveitis
- Peripheral anterior synechiae: seen in anterior uveitis
- Vitrous opacities: as snowballs/strings of pearls are seen in intermediate uveitis known as pars planitis.
- Chorioretinal peripheral lesions
- Nodular and segmental periphlebitis with or without candle wax drippings: signs of posterior uveitis
- Optic disc nodule
- Choroidal nodule
- Heerfordt's syndrome(uveoparotid fever): anterior uveitis, parotid gland enlargement, facial nerve palsy, and fever[12][13][14]
Gallery
Skin
Head
Neck
Extremities
References
- ↑ Ungprasert P, Carmona EM, Utz JP, Ryu JH, Crowson CS, Matteson EL: Epidemiology of Sarcoidosis 1946-2013: A Population-Based Study. Mayo Clinic proceedings 2016, 91(2):183-188.
- ↑ Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Jr., Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ et al: Clinical characteristics of patients in a case control study of sarcoidosis. American journal of respiratory and critical care medicine 2001, 164(10 Pt 1):1885-1889.
- ↑ Rizzato G, Tinelli C: Unusual presentation of sarcoidosis. Respiration; international review of thoracic diseases 2005, 72(1):3-6.
- ↑ Nathan N, Marcelo P, Houdouin V, Epaud R, de Blic J, Valeyre D, Houzel A, Busson PF, Corvol H, Deschildre A et al: Lung sarcoidosis in children: update on disease expression and management. Thorax 2015, 70(6):537-542.
- ↑ Pattishall EN, Kendig EL, Jr.: Sarcoidosis in children. Pediatric pulmonology 1996, 22(3):195-203.
- ↑ Milman N, Hoffmann AL: Childhood sarcoidosis: long-term follow-up. The European respiratory journal 2008, 31(3):592-598.
- ↑ Mana J, Marcoval J, Graells J, Salazar A, Peyri J, Pujol R: Cutaneous involvement in sarcoidosis. Relationship to systemic disease. Archives of dermatology 1997, 133(7):882-888.
- ↑ Mangas C, Fernandez-Figueras MT, Fite E, Fernandez-Chico N, Sabat M, Ferrandiz C: Clinical spectrum and histological analysis of 32 cases of specific cutaneous sarcoidosis. Journal of cutaneous pathology 2006, 33(12):772-777.
- ↑ Elgart ML: Cutaneous sarcoidosis: definitions and types of lesions. Clinics in dermatology 1986, 4(4):35-45.
- ↑ Krasowska D, Schwartz RA, Wojnowska D, Mackiewicz B, Czelej D: Polymorphous cutaneous and chronic multisystem sarcoidosis. Acta dermatovenerologica Alpina, Pannonica, et Adriatica 2008, 17(1):26-30.
- ↑ Evans M, Sharma O, LaBree L, Smith RE, Rao NA: Differences in clinical findings between Caucasians and African Americans with biopsy-proven sarcoidosis. Ophthalmology 2007, 114(2):325-333.
- ↑ Herbort CP, Rao NA, Mochizuki M: International criteria for the diagnosis of ocular sarcoidosis: results of the first International Workshop On Ocular Sarcoidosis (IWOS). Ocular immunology and inflammation 2009, 17(3):160-169.
- ↑ James DG, Sharma OP: Parotid gland sarcoidosis. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG 2000, 17(1):27-32.
- ↑ Petropoulos IK, Zuber JP, Guex-Crosier Y: Heerfordt syndrome with unilateral facial nerve palsy: a rare presentation of sarcoidosis. Klinische Monatsblatter fur Augenheilkunde 2008, 225(5):453-456.