title: Radiologic Features of World Trade Center-related Sarcoidosis in Exposed NYC Fire Department Rescue Workers.
abstract: OBJECTIVE
  An increased incidence of sarcoidosis has been demonstrated in firefighters, supporting the concern that occupational/environmental exposure may pose an etiologic risk factor. This incidence increased further after September 11, 2001 following exposure to World Trade Center (WTC) dust and gases. We review computed tomography (CT) features in this population, comparing the range of findings and physiological correlates with those typically reported in unexposed individuals with pulmonary sarcoidosis.
  
  
  METHODS
  With CT imaging we retrospectively identified 46 patients with WTC-related sarcoidosis, between March 18, 2002 and April 5, 2014. Scans were independently reviewed by 2 dedicated thoracic radiologists and assessed for disease patterns and correlation with pulmonary functions.
  
  
  RESULTS
  The majority (37/46; 80%) had symmetric mediastinal and hilar lymphadenopathy. Similarly, most (38/46; 83%) had perilymphatic nodules. Foci of ill-defined ground glass attenuation were present in 6 (13%). Coalescent nodularity was present in 15 (33%). Only 3 (7%) had parenchymal reticulation. A mixed pattern of lung findings was present in 21 (46%). When all forms of parenchymal disease were scored by zonal distribution, 21 (46%) had parenchymal disease predominantly involving mid and upper lungs; 11/46 (24%) had a random distribution without zonal predominance; 6/46 (13%) demonstrated atypical lower zone predominance. Whereas 15/46 (33%) had obstructive airways disease on pulmonary function tests, there were no CT findings that were predictive of obstructive airways disease.
  
  
  CONCLUSIONS
  The majority of cases of WTC-related sarcoidosis demonstrated typical radiographic appearances of sarcoidosis, with symmetric hilar and mediastinal lymphadenopathy and mid to upper lung perilymphatic nodules; these findings were consistent with other previously reported cases of sarcoid-like granulomatous disease in association with various alternate underlying etiologies. There was no correlation between disease patterns or extent on CT and pulmonary function testing, likely at least in part due to the overall mild extent of disease in this population.
authors.affiliation: *The Department of Radiology, New York University Langone Medical Center §Department of Medicine, Pulmonary Division, New York University School of Medicine and Langone Medical Center, New York †Fire Department of the City of New York, World Trade Center Health Program, Brooklyn Departments of ‡Epidemiology and Population Health ∥Medicine, Pulmonary Division, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
authors.forename: Francis
authors.initials: F
authors.lastname: Girvin
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeig-Owens
authors.forename: Deepti
authors.initials: D
authors.lastname: Gupta
authors.forename: Theresa
authors.initials: T
authors.lastname: Schwartz
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: Michael D
authors.initials: MD
authors.lastname: Weiden
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
authors.forename: David P
authors.initials: DP
authors.lastname: Naidich
mesh_terms: D000328:Adult; D060731:Emergency Responders / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009519:New York City; D016273:Occupational Exposure; D012189:Retrospective Studies; D017565:Sarcoidosis, Pulmonary / Q000000981:diagnostic imaging*; D047851:September 11 Terrorist Attacks; D014057:Tomography, X-Ray Computed