EXCESSIVE THORACIC COMPUTED TOMOGRAPHIC SCANNING IN SARCOIDOSIS

Background - The clinical value of computed tomographic (CT) scanning of the chest in the initial assessment of sarcoidosis was investigated . Methods - One hundred consecutive patients referred to the sarcoidos is outpatient services of the Mount Sinai Medical Center, New York fro m 1990 to 1992 with a presumptive diagnosis of sarcoidosis were studie d. The diagnosis was subsequently confirmed in all by a positive tissu e biopsy sample or the Kveim-Siltzbach test. Clinical and laboratory d ata of each patient were reviewed. Chest radiographs were classified a ccording to the classical stages of sarcoidosis. Thirty five of the 10 0 patients had a CT scan of the chest performed before presentation. T he CT scans were compared with the presenting clinical data and standa rd chest radiographs in order to determine if they yielded useful addi tional information regarding diagnosis or treatment. Results - The che st CT scan revealed no additional clinically relevant information comp ared with conventional chest radiographs in any of the 35 studies perf ormed. In two patients mediastinal adenopathy was detected by CT scan which was not seen on standard radiographs. Two patients thought to ex hibit hilar adenopathy and pulmonary infiltrations by standard radiogr aphy had no parenchymal disease on the CT scan. Bilateral parenchymal infiltrates were seen in one patient which were interpreted as unilate ral infiltrates by standard radiographs. The variance between conventi onal radiographs and CT scans in these five patients was not clinicall y valuable. Conclusions - CT scans of the chest do not add clinically useful information to the standard chest radiographs in the initial as sessment of sarcoidosis in patients presenting with the typical standa rd radiological patterns. CT scanning of the thorax is indicated in pa tients with proven or suspected sarcoidosis when the standard chest ra diographs are normal or not typical of sarcoidosis, when signs or symp toms of upper airway obstruction are present, when the patient has hae moptysis, if there is a suspicion of a complicating second intrathorac ic disease, or the patient is a candidate for lung transplantation.