The Pulmonary Manifestations of Sarcoidosis

  • Marcel VeltkampEmail author
  • Jan C. Grutters
Part of the Respiratory Medicine book series (RM, volume 17)


The pulmonary manifestation of sarcoidosis has a great variability and is notorious for mimicking many other interstitial lung diseases. Knowledge of pulmonary manifestations is important in diagnosing saroidosis because thoracic involvement is present in over 90 % of patients. In this chapter, classical findings on chest X-ray and HRCT are described as well as multiple uncommon findings in radiology. The most common findings are bilateral hilar lymphadenopathy, reticulonodular pattern, perilymphatic distribution of nodules, and predominant upper- and middle lobe parenchymal abnormalities. Uncommon findings are unilateral lymphadenopathy, reticular pattern, excessive ground glass opacities, pleural disease, solitary mass, and predominant lower lobe parenchymal abnormalities. Furthermore, the appearance of pulmonary hypertension and necrotizing sarcoid granulomatosis will be described. Finally, imaging of pulmonary sarcoidosis with positron emission tomography with 18F-Fluordeoxyglucose (18F-FDG PET) will be discussed.


Sarcoidosis Intrathoracic manifestations Lymphadenopathy Parenchymal involvement Pulmonary fibrosis Chest X-ray HRCT PET 



Bilateral hilar lymphadenopathy


Cryptogenic organizing pneumonia


High resolution computed tomography


Lymphocytic interstitial pneumonia


Necrotizing sarcoid angiitis and granulomatosis


Positron emission tomography


Secondary pulmonary lobule


Sarcoidosis of the upper respiratory tract


  1. 1.
    Hillerdal G, Nou E, Osterman K, Schmekel B. Sarcoidosis: epidemiology and prognosis. A 15-year European study. Am Rev Respir Dis. 1984;130(1):29–32.PubMedGoogle Scholar
  2. 2.
    Lynch 3rd JP, Kazerooni EA, Gay SE. Pulmonary sarcoidosis. Clin Chest Med. 1997;18(4): 755–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Reich JM. Mortality of intrathoracic sarcoidosis in referral vs population-based settings: influence of stage, ethnicity, and corticosteroid therapy. Chest. 2002;121(1):32–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Hendrick DJ, Blackwood RA, Black JM. Chest pain in the presentation of sarcoidosis. Br J Dis Chest. 1976;70(3):206–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Cappell MS. Endoscopic, radiographic, and manometric findings in dysphagia associated with sarcoid due to extrinsic esophageal compression from subcarinal lymphadenopathy. Am J Gastroenterol. 1995;90(3):489–92.PubMedGoogle Scholar
  6. 6.
    Scadding JG. Prognosis of intrathoracic sarcoidosis in England. A review of 136 cases after five years’ observation. Br Med J. 1961;2(5261):1165–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Grutters JC, Drent M, Van den Bosch JMM. European Respiratory Society Monograph 2009; 46(Interstitial Lung Diseases):126-54. doi: 10.1183/1025448x.00046008.
  8. 8.
    Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med. 1999;160(2):736–55.Google Scholar
  9. 9.
    Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager Jr H, Bresnitz EA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med. 2001;164(10 Pt 1):1885–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Nunes H, Brillet PY, Valeyre D, Brauner MW, Wells AU. Imaging in sarcoidosis. Semin Respir Crit Care Med. 2007;28(1):102–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Bechtel JJ, Starr 3rd T, Dantzker DR, Bower JS. Airway hyperreactivity in patients with sarcoidosis. Am Rev Respir Dis. 1981;124(6):759–61.PubMedGoogle Scholar
  12. 12.
    Marcias S, Ledda MA, Perra R, Severino C, Rosetti L. Aspecific bronchial hyperreactivity in pulmonary sarcoidosis. Sarcoidosis. 1994;11(2):118–22.PubMedGoogle Scholar
  13. 13.
    Shorr AF, Torrington KG, Hnatiuk OW. Endobronchial involvement and airway hyperreactivity in patients with sarcoidosis. Chest. 2001;120(3):881–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Baughman RP, Lower EE, Tami T. Upper airway. 4: Sarcoidosis of the upper respiratory tract (SURT). Thorax. 2010;65(2):181–6.PubMedCrossRefGoogle Scholar
  15. 15.
    James DG, Barter S, Jash D, MacKinnon DM, Carstairs LS. Sarcoidosis of the upper respiratory tract (SURT). J Laryngol Otol. 1982;96(8):711–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Panselinas E, Halstead L, Schlosser RJ, Judson MA. Clinical manifestations, radiographic findings, treatment options, and outcome in sarcoidosis patients with upper respiratory tract involvement. South Med J. 2010;103(9):870–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Shorr AF, Torrington KG, Hnatiuk OW. Endobronchial biopsy for sarcoidosis: a prospective study. Chest. 2001;120(1):109–14.PubMedCrossRefGoogle Scholar
  18. 18.
    Chambellan A, Turbie P, Nunes H, Brauner M, Battesti JP, Valeyre D. Endoluminal stenosis of proximal bronchi in sarcoidosis: bronchoscopy, function, and evolution. Chest. 2005;127(2): 472–81.PubMedCrossRefGoogle Scholar
  19. 19.
    Kirks DR, McCormick VD, Greenspan RH. Pulmonary sarcoidosis. Roentgenologic analysis of 150 patients. Am J Roentgenol Radium Ther Nucl Med. 1973;117(4):777–86.PubMedCrossRefGoogle Scholar
  20. 20.
    James DG, Neville E, Siltzbach LE. A worldwide review of sarcoidosis. Ann N Y Acad Sci. 1976;278:321–34.PubMedCrossRefGoogle Scholar
  21. 21.
    Siltzbach LE, James DG, Neville E, Turiaf J, Battesti JP, Sharma OP, et al. Course and prognosis of sarcoidosis around the world. Am J Med. 1974;57(6):847–52.PubMedCrossRefGoogle Scholar
  22. 22.
    Sider L, Horton Jr ES. Hilar and mediastinal adenopathy in sarcoidosis as detected by computed tomography. J Thorac Imaging. 1990;5(2):77–80.PubMedCrossRefGoogle Scholar
  23. 23.
    Patil SN, Levin DL. Distribution of thoracic lymphadenopathy in sarcoidosis using computed tomography. J Thorac Imaging. 1999;14(2):114–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Niimi H, Kang EY, Kwong JS, Carignan S, Muller NL. CT of chronic infiltrative lung disease: prevalence of mediastinal lymphadenopathy. J Comput Assist Tomogr. 1996;20(2):305–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Gawne-Cain ML, Hansell DM. The pattern and distribution of calcified mediastinal lymph nodes in sarcoidosis and tuberculosis: a CT study. Clin Radiol. 1996;51(4):263–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Rabinowitz JG, Ulreich S, Soriano C. The usual unusual manifestations of sarcoidosis and the “hilar haze” – a new diagnostic aid. Am J Roentgenol Radium Ther Nucl Med. 1974;120(4):821–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Romer FK. Presentation of sarcoidosis and outcome of pulmonary changes. Dan Med Bull. 1982;29(1):27–32.PubMedGoogle Scholar
  28. 28.
    Spann RW, Rosenow 3rd EC, DeRemee RA, Miller WE. Unilateral hilar or paratracheal adenopathy in sarcoidosis: a study of 38 cases. Thorax. 1971;26(3):296–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Murdoch J, Muller NL. Pulmonary sarcoidosis: changes on follow-up CT examination. AJR Am J Roentgenol. 1992;159(3):473–7.PubMedCrossRefGoogle Scholar
  30. 30.
    McLoud TC, Putman CE, Pascual R. Eggshell calcification with systemic sarcoidosis. Chest. 1974;66(5):515–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Webb WR. Thin-section CT, of the secondary pulmonary lobule: anatomy and the image – the 2004 Fleischner lecture. Radiology. 2006;239(2):322–38.PubMedCrossRefGoogle Scholar
  32. 32.
    McLoud TC, Epler GR, Gaensler EA, Burke GW, Carrington CB. A radiographic classification for sarcoidosis: physiologic correlation. Invest Radiol. 1982;17(2):129–38.PubMedCrossRefGoogle Scholar
  33. 33.
    Israel HL, Karlin P, Menduke H, DeLisser OG. Factors affecting outcome of sarcoidosis. Influence of race, extrathoracic involvement, and initial radiologic lung lesions. Ann N Y Acad Sci. 1986;465:609–18.PubMedCrossRefGoogle Scholar
  34. 34.
    Nishimura K, Itoh H, Kitaichi M, Nagai S, Izumi T. Pulmonary sarcoidosis: correlation of CT and histopathologic findings. Radiology. 1993;189(1):105–9.PubMedGoogle Scholar
  35. 35.
    Padley SP, Padhani AR, Nicholson A, Hansell DM. Pulmonary sarcoidosis mimicking cryptogenic fibrosing alveolitis on CT. Clin Radiol. 1996;51(11):807–10.PubMedCrossRefGoogle Scholar
  36. 36.
    Sharma OP, Hewlett R, Gordonson J. Nodular sarcoidosis: an unusual radiographic appearance. Chest. 1973;64(2):189–92.PubMedCrossRefGoogle Scholar
  37. 37.
    Battesti JP, Saumon G, Valeyre D, Amouroux J, Pechnick B, Sandron D, et al. Pulmonary sarcoidosis with an alveolar radiographic pattern. Thorax. 1982;37(6):448–52.PubMedCrossRefGoogle Scholar
  38. 38.
    McNicol MW, Luce PJ. Sarcoidosis in a racially mixed community. J R Coll Physicians Lond. 1985;19(3):179–83.PubMedGoogle Scholar
  39. 39.
    Malaisamy S, Dalal B, Bimenyuy C, Soubani AO. The clinical and radiologic features of nodular pulmonary sarcoidosis. Lung. 2009;187(1):9–15.PubMedCrossRefGoogle Scholar
  40. 40.
    Edelman RR, Johnson TS, Jhaveri HS, Kim D, Kasdon E, Frank HA, et al. Fatal hemoptysis resulting from erosion of a pulmonary artery in cavitary sarcoidosis. AJR Am J Roentgenol. 1985;145(1):37–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Loh GA, Lettieri CJ, Shah AA. Bronchial arterial embolisation for massive haemoptysis in cavitary sarcoidosis. BMJ Case Rep. 2013. doi: 10.1136/bcr-2012-008268.Google Scholar
  42. 42.
    Leung AN, Brauner MW, Caillat-Vigneron N, Valeyre D, Grenier P. Sarcoidosis activity: correlation of HRCT findings with those of 67Ga scanning, bronchoalveolar lavage, and serum angiotensin-converting enzyme assay. J Comput Assist Tomogr. 1998;22(2):229–34.PubMedCrossRefGoogle Scholar
  43. 43.
    Brauner MW, Grenier P, Mompoint D, Lenoir S, de Cremoux H. Pulmonary sarcoidosis: evaluation with high-resolution CT. Radiology. 1989;172(2):467–71.PubMedGoogle Scholar
  44. 44.
    Abehsera M, Valeyre D, Grenier P, Jaillet H, Battesti JP, Brauner MW. Sarcoidosis with pulmonary fibrosis: CT patterns and correlation with pulmonary function. AJR Am J Roentgenol. 2000;174(6):1751–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Remy-Jardin M, Giraud F, Remy J, Wattinne L, Wallaert B, Duhamel A. Pulmonary sarcoidosis: role of CT in the evaluation of disease activity and functional impairment and in prognosis assessment. Radiology. 1994;191(3):675–80.PubMedGoogle Scholar
  46. 46.
    Marchiori E, Zanetti G, Barreto MM, de Andrade FT, Rodrigues RS. Atypical distribution of small nodules on high resolution CT studies: patterns and differentials. Respir Med. 2011;105(9):1263–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Voloudaki AE, Bouros DE, Froudarakis ME, Datseris GE, Apostolaki EG, Gourtsoyiannis NC. Crescentic and ring-shaped opacities. CT features in two cases of bronchiolitis obliterans organizing pneumonia (BOOP). Acta Radiol. 1996;37(6):889–92.PubMedCrossRefGoogle Scholar
  48. 48.
    Marchiori E, Zanetti G, Mano CM, Hochhegger B, Irion KL. The reversed halo sign: another atypical manifestation of sarcoidosis. Korean J Radiol. 2010;11(2):251–2.PubMedCrossRefGoogle Scholar
  49. 49.
    Zompatori M, Poletti V, Battista G, Diegoli M. Bronchiolitis obliterans with organizing pneumonia (BOOP), presenting as a ring-shaped opacity at HRCT (the atoll sign). A case report. Radiol Med. 1999;97(4):308–10.PubMedGoogle Scholar
  50. 50.
    Marten K, Rummeny EJ, Engelke C. The CT halo: a new sign in active pulmonary sarcoidosis. Br J Radiol. 2004;77(924):1042–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Grenier P, Chevret S, Beigelman C, Brauner MW, Chastang C, Valeyre D. Chronic diffuse infiltrative lung disease: determination of the diagnostic value of clinical data, chest radiography, and CT and Bayesian analysis. Radiology. 1994;191(2):383–90.PubMedGoogle Scholar
  52. 52.
    Grenier P, Valeyre D, Cluzel P, Brauner MW, Lenoir S, Chastang C. Chronic diffuse interstitial lung disease: diagnostic value of chest radiography and high-resolution CT. Radiology. 1991;179(1):123–32.PubMedGoogle Scholar
  53. 53.
    Martin SG, Kronek LP, Valeyre D, Brauner N, Brillet PY, Nunes H, et al. High-resolution computed tomography to differentiate chronic diffuse interstitial lung diseases with predominant ground-glass pattern using logical analysis of data. Eur Radiol. 2010;20(6):1297–310.PubMedCrossRefGoogle Scholar
  54. 54.
    Moller DR. Pulmonary fibrosis of sarcoidosis. New approaches, old ideas. Am J Respir Cell Mol Biol. 2003;29(3 Suppl):S37–41.PubMedGoogle Scholar
  55. 55.
    Freundlich IM, Libshitz HI, Glassman LM, Israel HL. Sarcoidosis. Typical and atypical thoracic manifestations and complications. Clin Radiol. 1970;21(4):376–83.PubMedCrossRefGoogle Scholar
  56. 56.
    Primack SL, Hartman TE, Hansell DM, Muller NL. End-stage lung disease: CT findings in 61 patients. Radiology. 1993;189(3):681–6.PubMedGoogle Scholar
  57. 57.
    Davies CW, Tasker AD, Padley SP, Davies RJ, Gleeson FV. Air trapping in sarcoidosis on computed tomography: correlation with lung function. Clin Radiol. 2000;55(3):217–21.PubMedCrossRefGoogle Scholar
  58. 58.
    Hansell DM, Milne DG, Wilsher ML, Wells AU. Pulmonary sarcoidosis: morphologic associations of airflow obstruction at thin-section CT. Radiology. 1998;209(3):697–704.PubMedGoogle Scholar
  59. 59.
    Bartz RR, Stern EJ. Airways obstruction in patients with sarcoidosis: expiratory CT scan findings. J Thorac Imaging. 2000;15(4):285–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Pena TA, Soubani AO, Samavati L. Aspergillus lung disease in patients with sarcoidosis: a case series and review of the literature. Lung. 2011;189(2):167–72.PubMedCrossRefGoogle Scholar
  61. 61.
    Pesle GD, Monod O. Bronchiectasis due to asperigilloma. Dis Chest. 1954;25(2):172–83.PubMedCrossRefGoogle Scholar
  62. 62.
    Chusid EL, Siltzbach LE. Sarcoidosis of the pleura. Ann Intern Med. 1974;81(2):190–4.PubMedCrossRefGoogle Scholar
  63. 63.
    Sharma OP, Gordonson J. Pleural effusion in sarcoidosis: a report of six cases. Thorax. 1975;30(1):95–101.PubMedCrossRefGoogle Scholar
  64. 64.
    Beekman JF, Zimmet SM, Chun BK, Miranda AA, Katz S. Spectrum of pleural involvement in sarcoidosis. Arch Intern Med. 1976;136(3):323–30.PubMedCrossRefGoogle Scholar
  65. 65.
    Wilen SB, Rabinowitz JG, Ulreich S, Lyons HA. Pleural involvement in sarcoidosis. Am J Med. 1974;57(2):200–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Tommasini A, Di Vittorio G, Facchinetti F, Festi G, Schito V, Cipriani A. Pleural effusion in sarcoidosis: a case report. Sarcoidosis. 1994;11(2):138–40.PubMedGoogle Scholar
  67. 67.
    Soskel NT, Sharma OP. Pleural involvement in sarcoidosis. Curr Opin Pulm Med. 2000;6(5):455–68.PubMedCrossRefGoogle Scholar
  68. 68.
    Huggins JT, Doelken P, Sahn SA, King L, Judson MA. Pleural effusions in a series of 181 outpatients with sarcoidosis. Chest. 2006;129(6):1599–604.PubMedCrossRefGoogle Scholar
  69. 69.
    Littner MR, Schachter EN, Putman CE, Odero DO, Gee JB. The clinical assessment of roentgenographically atypical pulmonary sarcoidosis. Am J Med. 1977;62(3):361–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Aberg H, Bah M, Waters AW. Sarcoidosis: complicated by chylothorax. Minn Med. 1966;49(7):1065–70.PubMedGoogle Scholar
  71. 71.
    Jarman PR, Whyte MK, Sabroe I, Hughes JM. Sarcoidosis presenting with chylothorax. Thorax. 1995;50(12):1324–5.PubMedCrossRefGoogle Scholar
  72. 72.
    Lengyel RJ, Shanley DJ. Recurrent chylothorax associated with sarcoidosis. Hawaii Med J. 1995;54(12):817–8.PubMedGoogle Scholar
  73. 73.
    Parker JM, Torrington KG, Phillips YY. Sarcoidosis complicated by chylothorax. South Med J. 1994;87(8):860–2.PubMedCrossRefGoogle Scholar
  74. 74.
    Hours S, Nunes H, Kambouchner M, Uzunhan Y, Brauner MW, Valeyre D, et al. Pulmonary cavitary sarcoidosis: clinico-radiologic characteristics and natural history of a rare form of sarcoidosis. Medicine (Baltimore). 2008;87(3):142–51.CrossRefGoogle Scholar
  75. 75.
    Froudarakis ME, Bouros D, Voloudaki A, Papiris S, Kottakis Y, Constantopoulos SH, et al. Pneumothorax as a first manifestation of sarcoidosis. Chest. 1997;112(1):278–80.PubMedCrossRefGoogle Scholar
  76. 76.
    Akelsson IG, Eklund A, Skold CM, Tornling G. Bilateral spontaneous pneumothorax and sarcoidosis. Sarcoidosis. 1990;7(2):136–8.PubMedGoogle Scholar
  77. 77.
    Popper HH, Klemen H, Colby TV, Churg A. Necrotizing sarcoid granulomatosis – is it different from nodular sarcoidosis? Pneumologie. 2003;57(5):268–71.PubMedCrossRefGoogle Scholar
  78. 78.
    Koss MN, Hochholzer L, Feigin DS, Garancis JC, Ward PA. Necrotizing sarcoid-like granulomatosis: clinical, pathologic, and immunopathologic findings. Hum Pathol. 1980;11(5 Suppl):510–9.PubMedGoogle Scholar
  79. 79.
    Rosen Y. Pathology of sarcoidosis. Semin Respir Crit Care Med. 2007;28(1):36–52.PubMedCrossRefGoogle Scholar
  80. 80.
    Liebow AA. The J. Burns Amberson lecture – pulmonary angiitis and granulomatosis. Am Rev Respir Dis. 1973;108(1):1–18.PubMedGoogle Scholar
  81. 81.
    Yeboah J, Afkhami M, Lee C, Sharma OP. Necrotizing sarcoid granulomatosis. Curr Opin Pulm Med. 2012;18(5):493–8.PubMedCrossRefGoogle Scholar
  82. 82.
    Handa T, Nagai S, Miki S, Fushimi Y, Ohta K, Mishima M, et al. Incidence of pulmonary hypertension and its clinical relevance in patients with sarcoidosis. Chest. 2006;129(5):1246–52.PubMedCrossRefGoogle Scholar
  83. 83.
    Sulica R, Teirstein AS, Kakarla S, Nemani N, Behnegar A, Padilla ML. Distinctive clinical, radiographic, and functional characteristics of patients with sarcoidosis-related pulmonary hypertension. Chest. 2005;128(3):1483–9.PubMedCrossRefGoogle Scholar
  84. 84.
    Nunes H, Humbert M, Capron F, Brauner M, Sitbon O, Battesti JP, et al. Pulmonary hypertension associated with sarcoidosis: mechanisms, haemodynamics and prognosis. Thorax. 2006;61(1):68–74.PubMedCrossRefGoogle Scholar
  85. 85.
    Nunes H, Uzunhan Y, Freynet O, Humbert M, Brillet PY, Kambouchner M, et al. Pulmonary hypertension complicating sarcoidosis. Presse Med. 2012;41(6 Pt 2):e303–16.PubMedCrossRefGoogle Scholar
  86. 86.
    Braun JJ, Kessler R, Constantinesco A, Imperiale A. 18F-FDG PET/CT in sarcoidosis management: review and report of 20 cases. Eur J Nucl Med Mol Imaging. 2008;35(8):1537–43.PubMedCrossRefGoogle Scholar
  87. 87.
    Keijsers RG, Verzijlbergen FJ, Oyen WJ, van den Bosch JM, Ruven HJ, van Velzen-Blad H, et al. 18F-FDG PET, genotype-corrected ACE and sIL-2R in newly diagnosed sarcoidosis. Eur J Nucl Med Mol Imaging. 2009;36(7):1131–7.PubMedCrossRefGoogle Scholar
  88. 88.
    Teirstein AS, Machac J, Almeida O, Lu P, Padilla ML, Iannuzzi MC. Results of 188 whole-body fluorodeoxyglucose positron emission tomography scans in 137 patients with sarcoidosis. Chest. 2007;132(6):1949–53.PubMedCrossRefGoogle Scholar
  89. 89.
    Mostard RL, Voo S, van Kroonenburgh MJ, Verschakelen JA, Wijnen PA, Nelemans PJ, et al. Inflammatory activity assessment by F18 FDG-PET/CT in persistent symptomatic sarcoidosis. Respir Med. 2011;105(12):1917–24.PubMedCrossRefGoogle Scholar
  90. 90.
    Keijsers RG, Verzijlbergen EJ, van den Bosch JM, Zanen P, van de Garde EM, Oyen WJ, et al. 18F-FDG PET as a predictor of pulmonary function in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2011;28(2):123–9.PubMedGoogle Scholar

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© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of PulmonologySt. Antonius HospitalNieuwegeinThe Netherlands
  2. 2.Center of Interstitial Lung DiseasesSt. Antonius HospitalNieuwegeinThe Netherlands
  3. 3.Division Heart & LungsUniversity Medical CenterUtrechtThe Netherlands

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