PULMONARY SARCOIDOSIS WITH A DIFFUSE GROUND GLASS PATTERN ON THE CHEST RADIOGRAPH

Background - Several chest radiographic abnormalities have been descri bed in pulmonary sarcoidosis, but a diffuse ground glass pattern is ex tremely rare. Methods - The chest radiographs of more than 1600 patien ts with sarcoidosis evaluated in bur service between 1976 and 1991 wer e reviewed to determine the prevalence of this pattern on chest radiog raphy at presentation, and to assess the clinical characteristics of t hese patients. Results - Ten patients (0.6%) were identified with diff use ground glass abnormalities on the chest radiograph (eight men); al l had associated hilar or mediastinal adenopathy. All patients were wh ite and nine were smokers or former smokers. Nine patients were sympto matic and six had inspiratory crackles on physical examination. As a g roup these patients were remarkable for the frequency and severity of physiological abnormalities and the presence of various findings typic ally associated with ''active'' disease. Nine patients were followed f or more than three years. All were treated with oral corticosteroids b ecause of significant symptoms or physiological abnormalities, or both . Symptoms and radiological abnormalities disappeared or improved in a ll patients, but recurred in a high proportion when steroids were tape red or discontinued. By December 1992 only three patients had been wit hdrawn from treatment. Conclusions - A diffuse ground glass pattern on the chest radiograph is unusual in patients with sarcoidosis and may occur more commonly in white subjects and cigarette smokers. Its prese nce suggests the existence of active disease of recent onset likely to require long term treatment with corticosteroids.