Sarcoidosis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: : Roshan Dinparasti Saleh M.D.

## Overview[edit | edit source]

Nearly half of the patients with sarcoidosis are diagnosed incidentally with a chest radiograph but the disease clinical picture can range from normal to severe organ failure.

## Physical examination[edit | edit source]

### Pulmonary Sarcoidosis[edit | edit source]

In half of the patients diagnosed with sarcoidosis, the disease is found incidentally by a CXR (bilateral hilar lymphadenopathy, reticular opacities) before the symptoms develop. Lung is the most common organ involved by sarcoidosis, but up to 30% percent of patients present with extra-pulmonary manifestations of sarcoidosis. The most common pattern of lung involvement in sarcoidosis is interstitial lung disease (other less common pulmonary manifestations include pneumothorax, pleural thickening, chylothorax, pulmonary hypertension)[1][2][3].

* Crackles are not commonly auscultated on lung examination. Wheezing may be heard when there is endobronchial involvement.
* In 8 to 15 year-old children, the disease presentation is similar to adults but younger children present with skin rash, arthritis, and red eye(uveitis). 90% of the children have an abnormal CXR[4][5][6].

### Cutaneous Sarcoidosis[edit | edit source]

Common types of skin involvement in sarcoidosis are:

* Papular sarcoidosis: usually involves lips, forehead, eyelids, neck, previous trauma sites, and alae nares.
* Nodular sarcoidosis: usually involves trunk and extensor surface of the arms and legs.
* Plaque-like sarcoidosis: commonly involves shoulders, arms, and back.
* Lupus pernio: purple or red indurated papules/plaques/nodules that commonly involves nose, cheeks, chin, and ears.
* Erythema nodosum: painful nodular lesions commonly involving anterior surface of lower extremities and is associated with good prognosis. Biopsy from erythema nodosum usually is not helpful.
* Subcutaneous sarcoidosis: resembles erythema nodosum but usually on upper extremities, and asymptomatic[7][8][9][10].

### Ocular Sarcoidosis[edit | edit source]

Ocular manifestations of sarcoidosis can be classified as anterior, intermediate, and posterior uveitis[11].

* Mutton-fat keratic precipitates : a sign of anterior uveitis
* Granulomatous keratic precipitates: a sign of anterior uveitis
* Koeppe Busacca: a sign of anterior uveitis
* Trabecular meshwork nodules: seen in anterior uveitis
* Peripheral anterior synechiae: seen in anterior uveitis
* Vitrous opacities: as snowballs/strings of pearls are seen in intermediate uveitis known as pars planitis.
* Chorioretinal peripheral lesions
* Nodular and segmental periphlebitis with or without candle wax drippings: signs of posterior uveitis
* Optic disc nodule
* Choroidal nodule
* Heerfordt's syndrome(uveoparotid fever): anterior uveitis, parotid gland enlargement, facial nerve palsy, and fever[12][13][14]

### Extra-ocular Orbital Sarcoidosis[edit | edit source]

involvement of extra-ocular orbital tissues by sarcoidosis can be seen as palpable mass, orbital swelling, conjunctival granulomas, lacrimal gland involvement, and extra-ocular muscles involvement[15]

### Cardiovascular Sarcoidosis[edit | edit source]

Cardiovascular involvement by sarcoidosis can range from heart block and arrhythmias to heart failure, valvular dysfuntion, pericardial disease, pulmonary hypertension and sudden cardiac death[16]

### Reticuloendothelial System[edit | edit source]

* Peripheral lymphadenopathy is seen in 40% of patients.
* Hepatomegaly is seen in 20% of hepatic sarcoid patients.
* Splenomegaly is seen in 6% of patients diagnosed with sarcoidosis[17][18][19].

### Musculoskeletal System[edit | edit source]

* Acute polyarthritis, especially symmetric involvement of the ankle joints presented as joint swelling, redness and tenderness[20]

# =[edit | edit source]

### Gallery[edit | edit source]

#### Skin[edit | edit source]

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

##### Head[edit | edit source]

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

##### Neck[edit | edit source]

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

##### Extremities[edit | edit source]

*     url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=412>

## References[edit | edit source]

1. ↑ Ungprasert P, Carmona EM, Utz JP, Ryu JH, Crowson CS, Matteson EL: Epidemiology of Sarcoidosis 1946-2013: A Population-Based Study. Mayo Clinic proceedings 2016, 91(2):183-188.
2. ↑ Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Jr., Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ et al: Clinical characteristics of patients in a case control study of sarcoidosis. American journal of respiratory and critical care medicine 2001, 164(10 Pt 1):1885-1889.
3. ↑ Rizzato G, Tinelli C: Unusual presentation of sarcoidosis. Respiration; international review of thoracic diseases 2005, 72(1):3-6.
4. ↑ Nathan N, Marcelo P, Houdouin V, Epaud R, de Blic J, Valeyre D, Houzel A, Busson PF, Corvol H, Deschildre A et al: Lung sarcoidosis in children: update on disease expression and management. Thorax 2015, 70(6):537-542.
5. ↑ Pattishall EN, Kendig EL, Jr.: Sarcoidosis in children. Pediatric pulmonology 1996, 22(3):195-203.
6. ↑ Milman N, Hoffmann AL: Childhood sarcoidosis: long-term follow-up. The European respiratory journal 2008, 31(3):592-598.
7. ↑ Mana J, Marcoval J, Graells J, Salazar A, Peyri J, Pujol R: Cutaneous involvement in sarcoidosis. Relationship to systemic disease. Archives of dermatology 1997, 133(7):882-888.
8. ↑ Mangas C, Fernandez-Figueras MT, Fite E, Fernandez-Chico N, Sabat M, Ferrandiz C: Clinical spectrum and histological analysis of 32 cases of specific cutaneous sarcoidosis. Journal of cutaneous pathology 2006, 33(12):772-777.
9. ↑ Elgart ML: Cutaneous sarcoidosis: definitions and types of lesions. Clinics in dermatology 1986, 4(4):35-45.
10. ↑ Krasowska D, Schwartz RA, Wojnowska D, Mackiewicz B, Czelej D: Polymorphous cutaneous and chronic multisystem sarcoidosis. Acta dermatovenerologica Alpina, Pannonica, et Adriatica 2008, 17(1):26-30.
11. ↑ Evans M, Sharma O, LaBree L, Smith RE, Rao NA: Differences in clinical findings between Caucasians and African Americans with biopsy-proven sarcoidosis. Ophthalmology 2007, 114(2):325-333.
12. ↑ Herbort CP, Rao NA, Mochizuki M: International criteria for the diagnosis of ocular sarcoidosis: results of the first International Workshop On Ocular Sarcoidosis (IWOS). Ocular immunology and inflammation 2009, 17(3):160-169.
13. ↑ James DG, Sharma OP: Parotid gland sarcoidosis. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG 2000, 17(1):27-32.
14. ↑ Petropoulos IK, Zuber JP, Guex-Crosier Y: Heerfordt syndrome with unilateral facial nerve palsy: a rare presentation of sarcoidosis. Klinische Monatsblatter fur Augenheilkunde 2008, 225(5):453-456.
15. ↑ Mavrikakis I, Rootman J: Diverse clinical presentations of orbital sarcoid. American journal of ophthalmology 2007, 144(5):769-775.
16. ↑ Darlington P, Gabrielsen A, Sorensson P, Cederlund K, Eklund A, Grunewald J: Cardiac involvement in Caucasian patients with pulmonary sarcoidosis. Respiratory research 2014, 15:15.
17. ↑ Vagal AS, Shipley R, Meyer CA: Radiological manifestations of sarcoidosis. Clinics in dermatology 2007, 25(3):312-325.
18. ↑ Warshauer DM, Lee JK: Imaging manifestations of abdominal sarcoidosis. AJR American journal of roentgenology 2004, 182(1):15-28.
19. ↑ Salazar A, Mana J, Corbella X, Albareda JM, Pujol R: Splenomegaly in sarcoidosis: a report of 16 cases. Sarcoidosis 1995, 12(2):131-134.
20. ↑ Kellner H, Spathling S, Herzer P: Ultrasound findings in Lofgren's syndrome: is ankle swelling caused by arthritis, tenosynovitis or periarthritis? The Journal of rheumatology 1992, 19(1):38-41.

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