title: [Nine cases of pulmonary sarcoidosis predominantly affecting the lower lung fields].
abstract: OBJECTIVE
  Pulmonary sarcoidosis which predominantly affects the lower lung fields is relatively rare. We performed this study to clarify the clinical manifestations of this type of sarcoidosis.
  
  
  METHODS
  Over a period of 13 years, we diagnosed pulmonary sarcoidosis in 119 patients. Among these, we reviewed the clinical characteristics of 9 patients (3 men, 6 women, mean age 62 years) with pulmonary lesions predominantly affecting the lower lung fields.
  
  
  RESULTS
  Four patients had a history of dust inhalation and 6 had symptoms of dyspnea. All patients had ocular lesions and 5 had cutaneous lesions. Serum KL-6 levels were elevated in all patients, whereas angiotensin-converting-enzyme (ACE) levels were elevated in 3. Pulmonary function tests revealed stenosis in 4 patients, and decreased diffusion capacity in 7. Chest CT findings in the lower lung fields revealed bronchovascular thickening, micronodular opacities in the vessels and chest wall, and interlobular septal thickening in 8 patients; ground-glass opacities in 5; curvilinear shadows in 4; and patchy shadows, traction bronchiectasis, and pleural effusion in 3. Histopathologic findings of lung biopsy specimens featured granulomas in all patients, and pulmonary interstitium fibrosis and small round-cell infiltration in the alveoli of most patients.
  
  
  CONCLUSIONS
  Patients with sarcoidosis affecting the lower lung fields often had symptoms of dyspnea, extrapulmonary lesions in the eye and/or on the skin, and elevated serum KL-6 levels but not ACE. Chest CT showed findings typical of sarcoidosis, such as lymphatic distribution, but also showed unusual findings such as ground-glass opacities, curvilinear shadows, patchy shadows, traction bronchiectasis and pleural effusion. We speculated that 1 patient with ground-glass opacities and traction bronchiectasis without lymphatic distribution on CT, and fibroblastic foci with active alveolitis histopathologically, had complications of a different type of interstitial pneumonia.
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Tokyo National Hospital.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Matsui
authors.forename: Shinobu
authors.initials: S
authors.lastname: Akagawa
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Masuda
authors.forename: Azusa
authors.initials: A
authors.lastname: Yamato
authors.forename: Nobuharu
authors.initials: N
authors.lastname: Ohshima
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Matsui
authors.forename: Shinji
authors.initials: S
authors.lastname: Teramoto
authors.forename: Atsuhisa
authors.initials: A
authors.lastname: Tamura
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nagai
authors.forename: Akira
authors.initials: A
authors.lastname: Hebisawa
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018396:Mucin-1 / Q000097:blood; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D013902:Radiography, Thoracic; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis* / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; C060192:MUC1 protein, human; D018396:Mucin-1; D007703:Peptidyl-Dipeptidase A