Pulmonary sarcoidosis in a 14‐year‐old boy diagnosed by low‐dose CT‐guided transthoracic lung biopsy

• Published in: Pediatric pulmonology Vol. 41; no. 3; pp. 269 - 274
• Main Authors: Heyer, C.M., Mueller, K.M., Seiffert, P., Nicolas, V., Rieger, C.H.L., Nuesslein, T.G.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-03-2006; Wiley-Liss
• Subjects: Adolescent; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; biopsy; Biopsy - methods; children; computed tomography; CT guidance; Follow-Up Studies; Humans; Immunohistochemistry; lung; Male; Medical sciences; Pneumology; Radiography, Interventional; Risk Assessment; sarcoidosis; Sarcoidosis, Pulmonary - diagnostic imaging; Sarcoidosis, Pulmonary - drug therapy; Sarcoidosis, Pulmonary - pathology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sensitivity and Specificity; Severity of Illness Index; Tomography, X-Ray Computed - methods; Treatment Outcome; Human; computed tomography; Pediatrics; Radiodiagnosis; Sarcoidosis; Respiratory disease; Low dose; Lung; CT guidance; Male; Guidance; Biopsy; children; Systemic disease; Medical imagery; Computerized axial tomography; Diagnosis; Child
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.20354

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. Pediatr Pulmonol. © 2006 Wiley‐Liss, Inc.