title: Pulmonary sarcoidosis in a 14-year-old boy diagnosed by low-dose CT-guided transthoracic lung biopsy.
abstract: Pulmonary sarcoidosis is a rare disease in the pediatric age group, characterized by the presence of epitheloid-cell granulomas. In stage 3 sarcoidosis, pulmonary infiltrates without hilar lymphadenopathy occur. Definitive diagnosis requires a histopathological specimen, which might be difficult to obtain by transbronchial biopsy. Multidetector computed tomography (MDCT)-guided transthoracic lung biopsy (TLB) is a well-established procedure in adults, but has only rarely been applied in children.A 14-year-old boy was admitted to hospital for evaluation of a chronic systemic disease with severe pulmonary manifestation. All investigations, including bronchosopy and bronchoalveolar lavage with microbiological and virological testing, had been negative. MDCT-guided TLB was performed on a 16-section scanner with a low-dose protocol (single slices, 120 kV, 20 mAs), using a 16-gauge biopsy device. The total effective dose was 0.4 mSv for the biopsy procedure. Histopathological examination revealed multiple epitheloid-cell granulomas with giant cells in the absence of microbiological or virological abnormalities. A diagnosis of stage 3 pulmonary sarcoidosis was made and systemic anti-inflammatory therapy was administered, which led to complete remission within weeks. MDCT-guided TLB can be a valuable instrument in assessing pulmonary manifestations of pediatric sarcoidosis, enabling precise histopathological diagnosis and adequate therapy. The use of low-dose protocols can substantially reduce radiation exposure without relevant loss of image information. MDCT-guided lung biopsy should be considered prior to open-lung surgery in selected patients with unclear pulmonary disease.
authors.affiliation: Institute of Diagnostic Radiology, Interventional Radiology, and Nuclear Medicine, Berufgenossenschaftliche Kliniken Bergmannsheil, Ruhr-University of Bochum, Bochum, Germany. christoph.m.heyer@rub.de
authors.forename: C M
authors.initials: CM
authors.lastname: Heyer
authors.forename: K M
authors.initials: KM
authors.lastname: Mueller
authors.forename: P
authors.initials: P
authors.lastname: Seiffert
authors.forename: V
authors.initials: V
authors.lastname: Nicolas
authors.forename: C H L
authors.initials: CH
authors.lastname: Rieger
authors.forename: T G
authors.initials: TG
authors.lastname: Nuesslein
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001706:Biopsy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D015641:Radiography, Interventional; D018570:Risk Assessment; D017565:Sarcoidosis, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents