Pleural Effusions in a Series of 181 Outpatients With Sarcoidosis: Conclusion

It is conceivable that pleural fluid formation is more frequent with active pulmonary sarcoidosis. A sarcoidosis-related PE was seen in 11.1% of our patients (1 of 9 patients) who had an exacerbation of pulmonary sarcoidosis compared to 0.6% of those who did not have an exacerbation (1 of172 patients). Although the frequency of sarcoid-related PEs and pulmonary sarcoid exacerbations was low, limiting the power of statistical analysis, these data did not show a statistically significant association between an exacerbation of pulmonary sarcoidosis and the development of PE. cfm-online-shop.com

The management of sarcoid PEs should be individualized with the knowledge that a majority of these effusions resolve spontaneously in 1 to 3 months. However, there have been reports’ of resolution at 2 weeks with steroid therapy, and as long as 6 months with or without the administration of corticosteroids. In the absence of symptoms, the PE usually resolves spontaneously. Therapy with systemic corticosteroids should be considered for the symptomatic patient and if the effusion is recurrent. Incomplete resolution of the PE with progression to chronic pleural thickening or a trapped lung has been reported. Decortication has been successful in relieving dyspnea in a patient who had lung entrapment from sarcoidosis.

Our data show that PEs caused by sarcoid pleural involvement are rare even with a test as sensitive as ultrasonography. The frequency of all PEs was 2.8% and was only 1.1% for effusions due to sarcoid. We demonstrated the presence of a sarcoid PE in patients with stage 1 and 4 disease. Sarcoid-related PEs can be unilateral or bilateral. Because sarcoid-related PEs are rare, it should not be assumed that a PE occurring in a sarcoid patient is sarcoid-related; other causes of the PE should be considered. A sarcoid-related PE is a paucicellular, lymphocyte-predominant exudate, with a pleural fluid/serum protein ratio that is more consistently in the exudative range than with the pleural fluid LDH criterion (ie, pleural fluid LDH concentration compared to the upper limits of normal for serum LDH concentration). A definitive diagnosis of a sarcoid PE relies on a biopsy demonstrating noncaseating granuloma, with the exclusion of alternate granulomatous diseases. Our data show that an exacerbation of pulmonary sarcoidosis is not an independent risk factor for the development of a sarcoid PE.