[Hemoptysis in sarcoidosis. Apropos of 6 cases including 4 with fatal outcome].
Haemoptysis rarely occurs in sarcoidosis. Most cases usually occur in patients with advanced disease and major fibrosis. We observed 6 cases including 5 with fibrosis and 1 with inaugural unilateral lymph node involvement. Haemoptysis is a sign of gravity since it is the second most frequent cause of death described in the literature. In our series 4 of the 6 cases were fatal. Aspergillus colonization of a cavity is the most frequently found aggravating factor. Ideally, surgery is indicated but usually cannot be performed due to the patients respiratory function and the extent of the lesions. Oral drugs have little effect. Certain authors have had success with local, initially intrabronchic anti-aspergillus treatment. CT-guided application is often helpful. Embolization may stop the bleeding but in the long-term, a more or less voluminous haemoptysis often recurs. Other causes of bleeding are rare. Systemic hypervascularization of sarcoidosis lesions has been proposed as one mechanism other than infection. The cause may also be a simple granuloma. Symptomatic initial treatment by embolization is also proposed in these cases. Finally, massive haemoptysis can occur by erosion of the pulmonary artery due to a necrotic sarcoidosis lesion. In our series, surgery was impossible in three patients who died. In the three others, embolization was possible in 2 and the third underwent successful surgery.
Lemay
V
V
l'hôpital Tenon, Paris.
Carette
M F
MF
Parrot
A
A
Bazelly
B
B
Grivaux
M
M
Milleron
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000209:etiology / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006469:Hemoptysis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008172:Lung Diseases, Fungal / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy
Les hémoptysies des sarcoïdoses. A propos de 6 cas dont 4 mortels.