Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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Sarcoidosis is a disease that causes inflammation and the formation of small clusters of immune cells, called granulomas, in different organs. Although it most often affects the lungs and lymph nodes, it can also appear in the skin, eyes, heart, and nervous system. This makes sarcoidosis a condition that can look very different from person to person. The disease occurs when the immune system overreacts to an unknown stimulus and fails to turn off properly after the initial trigger. At Liv Hospital, we see sarcoidosis as more than just a lung problem. We approach it as a condition that can affect the whole body and requires a broad view to understand its effects on health and daily life.
A key feature of sarcoidosis is the presence of non-caseating granulomas. To understand what this means, it helps to look at the changes that happen in the body’s tissues under a microscope, as these changes cause the symptoms people experience.
The process begins when certain immune cells, T-lymphocytes and macrophages, respond to an unknown trigger. These cells send out signals that attract more immune cells to the area. Together, they form a tight group of cells to try to contain the problem. Unlike the granulomas in tuberculosis, those in sarcoidosis do not have a dead or “cheesy” center. This difference is important for doctors when looking at tissue samples.
As more granulomas form, they can alter the normal structure of the organ they inhabit. In the lungs, they form in the tissue between the air sacs, causing inflammation and, in some cases, scarring. This scarring makes the lungs stiff and less able to take in oxygen. If the granulomas persist, the disease becomes long-lasting; if they resolve, the disease is considered in remission.
Sarcoidosis affects the whole body, but the most noticeable symptoms usually involve the lungs and breathing.
This is the most common manifestation, affecting over 90 percent of patients. It involves the formation of granulomas in the lung parenchyma and the mediastinal lymph nodes. The condition can range from asymptomatic enlargement of lymph nodes to severe pulmonary fibrosis that compromises breathing function.
Sarcoidosis can affect more than just the lungs. It may also involve the skin, eyes, liver, spleen, heart, or brain. Because of this, someone with a skin rash or blurry vision could have the same disease as someone with a long-lasting cough.
Knowing who is more likely to get sarcoidosis helps doctors recognize and diagnose it. The disease is found worldwide, but it is more common in some ethnic and racial groups than others.
Genetics: There is a familial clustering of cases, suggesting a genetic predisposition. Specific HLA genes have been associated with both protection from and susceptibility to the disease.
Doctors do not know exactly what causes sarcoidosis. The current idea is that it happens when a person with certain genes has an unusually strong immune reaction to something in the environment.
Autoimmunity: While not a classic autoimmune disease where the body attacks “self” antigens, the dysregulated immune response shares features with autoimmune disorders, leading to the question of whether sarcoidosis is an autoimmune disease in many medical discussions.
Sarcoidosis changes over time and goes through different phases, which helps guide how doctors treat it.
While many patients recover without treatment, sarcoidosis can be fatal in a small percentage of cases.
A critical part of the definition involves distinguishing it from other granulomatous diseases.
Lymphoma: Enlarged lymph nodes in the chest can be a sign of both sarcoidosis and lymphoma (cancer of the lymph system). A biopsy is often required to rule out malignancy, answering the common patient fear of sarcoidosis cancer with a definitive diagnosis.
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CT scans use X-rays to create detailed cross-sectional images and are excellent for visualizing kidney stones, detecting tumors, and evaluating traumatic injuries. They are fast and widely available. MRI uses strong magnetic fields and radio waves to produce detailed images of soft tissues, making it superior for staging prostate cancer, evaluating bladder wall invasion, and assessing pelvic floor disorders without ionizing radiation.
Contrast dye, usually iodine-based, is injected into a vein to highlight the blood vessels and urinary tract organs. As the kidneys filter the dye from the blood, it opacifies the urine. This allows the radiologist to see the internal structure of the kidneys, the ureters, and the bladder clearly, revealing blockages, tumors, or structural abnormalities that would be invisible on a non-contrast scan.
Multiparametric MRI is an advanced imaging technique that combines standard anatomical sequences with functional sequences like Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced imaging. This provides a comprehensive assessment of the prostate, allowing doctors to distinguish between benign conditions like BPH and significant prostate cancer, and to guide targeted biopsies.
CT scans do involve exposure to ionizing radiation, which carries a small theoretical risk of cellular damage over time. However, modern CT scanners use dose-modulation technology to minimize this exposure to the lowest level necessary for a diagnostic image. The benefit of an accurate and timely diagnosis for serious urological conditions typically far outweighs the minimal risk of radiation.
Many modern orthopedic implants are MRI-safe, although they may cause some image distortion. However, older pacemakers, defibrillators, and certain metal clips may be unsafe in the strong magnetic field. It is critical to inform the imaging team of any metallic implants so they can verify their safety compatibility or recommend an alternative test like a CT scan.
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