Skip to main content
SpringerLink
Log in

Sarcoidosis of the Upper and Lower Airways

  • Chapter
  • First Online:
Diseases of the Central Airways

Part of the book series: Respiratory Medicine ((RM))

Abstract

Sarcoidosis involves the respiratory system in 90–95 % of patients, but has conventionally been viewed as a disease of lung parenchyma with restrictive physiologic abnormalities. However, granulomatous inflammation in sarcoidosis has a predilection for the airway submucosa, and therefore, clinical and subclinical airway involvement is common. Approximately 40–60 % of patients with sarcoidosis have some evidence of airway disease. Any structure from the tip of the nares to the terminal bronchioles may be affected. Since the symptoms from airway sarcoidosis are non-specific, diagnosis requires a high index of suspicion, supplemented by pulmonary function testing, imaging and direct fiberoptic visualization. Many of the airway manifestations of sarcoidosis are due to granulomatous inflammation and therefore treated with topical or systemic immunosuppressive medications. However, fibrotic sequelae of airway sarcoidosis generally require mechanical therapies such as bronchoplasty or debulking surgery, to relieve symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Judson MA, et al. The diagnostic pathway to sarcoidosis. Chest. 2003;123(2):406–12.

    Article  PubMed  Google Scholar 

  2. Rodrigues MM, et al. Delayed diagnosis of sarcoidosis is common in Brazil. J Bras Pneumol. 2013;39(5):539–46.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Panselinas E, et al. Clinical manifestations, radiographic findings, treatment options, and outcome in sarcoidosis patients with upper respiratory tract involvement. South Med J. 2010;103(9):870–5.

    Article  PubMed  Google Scholar 

  4. Braun JJ, Gentine A, Pauli G. Sinonasal sarcoidosis: review and report of fifteen cases. Laryngoscope. 2004;114(11):1960–3.

    Article  PubMed  Google Scholar 

  5. Baughman RP, Lower EE, Tami T. Upper airway. 4: Sarcoidosis of the upper respiratory tract (SURT). Thorax. 2010;65(2):181–6.

    Article  PubMed  Google Scholar 

  6. Lavergne F, et al. Airway obstruction in bronchial sarcoidosis: outcome with treatment. Chest. 1999;116(5):1194–9.

    Article  CAS  PubMed  Google Scholar 

  7. Neville E, et al. Sarcoidosis of the upper respiratory tract and its association with lupus pernio. Thorax. 1976;31(6):660–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Viskum K, Vestbo J. Vital prognosis in intrathoracic sarcoidosis with special reference to pulmonary function and radiological stage. Eur Respir J. 1993;6(3):349–53.

    CAS  PubMed  Google Scholar 

  9. Neville E, Walker AN, James DG. Prognostic factors predicting the outcome of sarcoidosis: an analysis of 818 patients. Q J Med. 1983;52(208):525–33.

    CAS  PubMed  Google Scholar 

  10. Baughman RP, 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.

    Article  CAS  PubMed  Google Scholar 

  11. Reed J, et al. Clinical features of sarcoid rhinosinusitis. Am J Med. 2010;123(9):856–62.

    Article  PubMed  Google Scholar 

  12. Aloulah M, et al. Sinonasal manifestations of sarcoidosis: a single institution experience with 38 cases. Int Forum Allergy Rhinol. 2013;3(7):567–72.

    Article  PubMed  Google Scholar 

  13. Hasni SA, Gruber BL. Sarcoidosis presenting as necrotizing sinus destruction mimicking Wegener’s granulomatosis. J Rheumatol. 2000;27(2):512–4.

    CAS  PubMed  Google Scholar 

  14. Weiss JA. Sarcoidosis in otolaryngology. Report of eleven cases. Evaluation of blind biopsy as a diagnostic aid. Laryngoscope. 1960;70:1351–98.

    Article  CAS  PubMed  Google Scholar 

  15. Davis C, Girzadas DV Jr. Laryngeal sarcoidosis causing acute upper airway obstruction. Am J Emerg Med. 2008;26(1):114 e1–3.

    Article  PubMed  Google Scholar 

  16. Aubart FC, et al. Sinonasal involvement in sarcoidosis: a case-control study of 20 patients. Medicine (Baltimore). 2006;85(6):365–71.

    Article  Google Scholar 

  17. Krespi YP, Kuriloff DB, Aner M. Sarcoidosis of the sinonasal tract: a new staging system. Otolaryngol Head Neck Surg. 1995;112(2):221–7.

    Article  CAS  PubMed  Google Scholar 

  18. Fergie N, Jones NS, Havlat MF. The nasal manifestations of sarcoidosis: a review and report of eight cases. J Laryngol Otol. 1999;113(10):893–8.

    Article  CAS  PubMed  Google Scholar 

  19. Zeitlin JF, et al. Nasal and sinus manifestations of sarcoidosis. Am J Rhinol. 2000;14(3):157–61.

    Article  CAS  PubMed  Google Scholar 

  20. Sahoo DH, et al. Effectiveness and safety of leflunomide for pulmonary and extrapulmonary sarcoidosis. Eur Respir J. 2011;38(5):1145–50.

    Article  CAS  PubMed  Google Scholar 

  21. Judson MA, et al. Efficacy of infliximab in extrapulmonary sarcoidosis: results from a randomised trial. Eur Respir J. 2008;31(6):1189–96.

    Article  CAS  PubMed  Google Scholar 

  22. Krespi YP, et al. Treatment of laryngeal sarcoidosis with intralesional steroid injection. Ann Otol Rhinol Laryngol. 1987;96(6):713–5.

    Article  CAS  PubMed  Google Scholar 

  23. Carasso B. Sarcoidosis of the larynx causing airway obstruction. Chest. 1974;65(6):693–5.

    Article  CAS  PubMed  Google Scholar 

  24. McKelvie P, et al. Sarcoidosis of the upper air passages. Br J Dis Chest. 1968;62(4):200–6.

    Article  CAS  PubMed  Google Scholar 

  25. Sakamoto M, Ishizawa M, Kitahara N. Polypoid type of laryngeal sarcoidosis–case report and review of the literature. Eur Arch Otorhinolaryngol. 2000;257(8):436–8.

    Article  CAS  PubMed  Google Scholar 

  26. Gerencer RZ, Keohane JD Jr, Russell L. Laryngeal sarcoidosis with airway obstruction. J Otolaryngol. 1998;27(2):90–3.

    CAS  PubMed  Google Scholar 

  27. Fogel TD, et al. Radiotherapy in sarcoidosis of the larynx: case report and review of the literature. Laryngoscope. 1984;94(9):1223–5.

    Article  CAS  PubMed  Google Scholar 

  28. Marks SC, Goodman RS. Surgical management of nasal and sinus sarcoidosis. Otolaryngol Head Neck Surg. 1998;118(6):856–8.

    Article  CAS  PubMed  Google Scholar 

  29. Rubinstein I, et al. Hemoptysis in sarcoidosis. Eur J Respir Dis. 1985;66(4):302–5.

    CAS  PubMed  Google Scholar 

  30. Harrison BD, et al. Airflow limitation in sarcoidosis–a study of pulmonary function in 107 patients with newly diagnosed disease. Respir Med. 1991;85(1):59–64.

    Article  CAS  PubMed  Google Scholar 

  31. Gibson GJ, et al. British Thoracic Society Sarcoidosis study: effects of long term corticosteroid treatment. Thorax. 1996;51(3):238–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Sharma OP, Johnson R. Airway obstruction in sarcoidosis. A study of 123 nonsmoking black American patients with sarcoidosis. Chest. 1988;94(2):343–6.

    Article  CAS  PubMed  Google Scholar 

  33. Handa T, et al. Clinical and radiographic indices associated with airflow limitation in patients with sarcoidosis. Chest. 2006;130(6):1851–6.

    Article  PubMed  Google Scholar 

  34. Torrington KG, Shorr AF, Parker JW. Endobronchial disease and racial differences in pulmonary sarcoidosis. Chest. 1997;111(3):619–22.

    Article  CAS  PubMed  Google Scholar 

  35. Burke RR, et al. Racial differences in sarcoidosis granuloma density. Lung. 2009;187(1):1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Argyropoulou PK, Patakas DA, Louridas GE. Airway function in stage I and stage II pulmonary sarcoidosis. Respiration. 1984;46(1):17–25.

    Article  CAS  PubMed  Google Scholar 

  37. Shorr AF, Torrington KG, Hnatiuk OW. Endobronchial biopsy for sarcoidosis: a prospective study. Chest. 2001;120(1):109–14.

    Article  CAS  PubMed  Google Scholar 

  38. Bjermer L, et al. Endobronchial biopsy positive sarcoidosis: relation to bronchoalveolar lavage and course of disease. Respir Med. 1991;85(3):229–34.

    Article  CAS  PubMed  Google Scholar 

  39. Armstrong JR, et al. Endoscopic findings in sarcoidosis. Characteristics and correlations with radiographic staging and bronchial mucosal biopsy yield. Ann Otol Rhinol Laryngol. 1981; 90(4 Pt 1):339–43.

    Google Scholar 

  40. Bilaceroglu S, et al. Combining transbronchial aspiration with endobronchial and transbronchial biopsy in sarcoidosis. Monaldi Arch Chest Dis. 1999;54(3):217–23.

    CAS  PubMed  Google Scholar 

  41. Gupta D, et al. Endobronchial vis a vis transbronchial involvement on fiberoptic bronchoscopy in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2001;18(1):91–2.

    CAS  PubMed  Google Scholar 

  42. Lenique F, et al. CT assessment of bronchi in sarcoidosis: endoscopic and pathologic correlations. Radiology. 1995;194(2):419–23.

    Article  CAS  PubMed  Google Scholar 

  43. Davies CW, et al. Air trapping in sarcoidosis on computed tomography: correlation with lung function. Clin Radiol. 2000;55(3):217–21.

    Article  CAS  PubMed  Google Scholar 

  44. Judson MA, et al. The diagnostic pathway to sarcoidosis. Chest. 2003;123(2):406–12.

    Article  PubMed  Google Scholar 

  45. Shorr AF, Torrington KG, Hnatiuk OW. Endobronchial involvement and airway hyperreactivity in patients with sarcoidosis. Chest. 2001;120(3):881–6.

    Article  CAS  PubMed  Google Scholar 

  46. Bechtel JJ, et al. Airway hyperreactivity in patients with sarcoidosis. Am Rev Respir Dis. 1981;124(6):759–61.

    CAS  PubMed  Google Scholar 

  47. Marcias S, et al. Aspecific bronchial hyperreactivity in pulmonary sarcoidosis. Sarcoidosis. 1994;11(2):118–22.

    CAS  PubMed  Google Scholar 

  48. Hajdarbegovic E, et al. Prevalence of atopic diseases in patients with sarcoidosis. Allergy Asthma Proc. 2014;35(4):e57–61.

    Article  PubMed  Google Scholar 

  49. Chambellan A, et al. Endoluminal stenosis of proximal bronchi in sarcoidosis: bronchoscopy, function, and evolution. Chest. 2005;127(2):472–81.

    Article  PubMed  Google Scholar 

  50. Westcott JL, Noehren TH. Bronchial stenosis in chronic sarcoidosis. Chest. 1973;63(6):893–7.

    Article  CAS  PubMed  Google Scholar 

  51. Olsson T, Bjornstad-Pettersen H, Stjernberg NL. Bronchostenosis due to sarcoidosis: a cause of atelectasis and airway obstruction simulating pulmonary neoplasm and chronic obstructive pulmonary disease. Chest. 1979;75(6):663–6.

    Article  CAS  PubMed  Google Scholar 

  52. Miller A, Brown LK, Teirstein AS. Stenosis of main bronchi mimicking fixed upper airway obstruction in sarcoidosis. Chest. 1985;88(2):244–8.

    Article  CAS  PubMed  Google Scholar 

  53. Stjernberg N, Thunell M. Pulmonary function in patients with endobronchial sarcoidosis. Acta Med Scand. 1984;215(2):121–6.

    Article  CAS  PubMed  Google Scholar 

  54. Fouty BW, et al. Dilatation of bronchial stenoses due to sarcoidosis using a flexible fiberoptic bronchoscope. Chest. 1994;106(3):677–80.

    Article  CAS  PubMed  Google Scholar 

  55. Brown KT, Yeoh CB, Saddekni S. Balloon dilatation of the left main bronchus in sarcoidosis. AJR Am J Roentgenol. 1988;150(3):553–4.

    Article  CAS  PubMed  Google Scholar 

  56. Naccache JM, et al. High-resolution computed tomographic imaging of airways in sarcoidosis patients with airflow obstruction. J Comput Assist Tomogr. 2008;32(6):905–12.

    Article  PubMed  Google Scholar 

  57. Abehsera M, et al. Sarcoidosis with pulmonary fibrosis: CT patterns and correlation with pulmonary function. AJR Am J Roentgenol. 2000;174(6):1751–7.

    Article  CAS  PubMed  Google Scholar 

  58. Mostard RL, et al. Severity of pulmonary involvement and (18)F-FDG PET activity in sarcoidosis. Respir Med. 2013;107(3):439–47.

    Article  PubMed  Google Scholar 

  59. Vorselaars AD, et al. Effectiveness of infliximab in refractory FDG PET-positive sarcoidosis. Eur Respir J. 2015;46(1):175–85.

    Article  PubMed  Google Scholar 

  60. Mendelson DS, et al. Bronchial compression: an unusual manifestation of sarcoidosis. J Comput Assist Tomogr. 1983;7(5):892–4.

    Article  CAS  PubMed  Google Scholar 

  61. Arkless HA, Chodoff RJ. Middle lobe syndrome due to sarcoidosis. Dis Chest. 1956;30(3):351–3.

    Article  CAS  PubMed  Google Scholar 

  62. Abramowicz MJ, et al. Tumour-like presentation of pulmonary sarcoidosis. Eur Respir J. 1992;5(10):1286–7.

    CAS  PubMed  Google Scholar 

  63. Remy-Jardin M, et al. Pulmonary sarcoidosis: role of CT in the evaluation of disease activity and functional impairment and in prognosis assessment. Radiology. 1994;191(3):675–80.

    Article  CAS  PubMed  Google Scholar 

  64. Udwadia ZF, et al. Bronchoscopic and bronchographic findings in 12 patients with sarcoidosis and severe or progressive airways obstruction. Thorax. 1990;45(4):272–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Lewis MM, et al. Clinical bronchiectasis complicating pulmonary sarcoidosis: case series of seven patients. Sarcoidosis Vasc Diffuse Lung Dis. 2002;19(2):154–9.

    PubMed  Google Scholar 

  66. Xu L, Kligerman S, Burke A. End-stage Sarcoid Lung Disease Is Distinct From Usual Interstitial Pneumonia. Am J Surg Pathol. 2013;37(4):593–600.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A90, Cleveland, OH, 44195, USA

    Daniel A. Culver

  2. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A90, Cleveland, OH, 44195, USA

    Daniel A. Culver

Authors
  1. Daniel A. Culver
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel A. Culver .

Editor information

Editors and Affiliations

  1. Family Endowed Chair in Lung Transplanta, Lerner College of Medicine Buoncore, Clevland, Ohio, USA

    Atul C. Mehta

  2. Louis A Johnson VA Medical Center, Fairmont, West Virginia, USA

    Prasoon Jain

  3. Cleveland Clinic, Cleveland, Ohio, USA

    Thomas R. Gildea

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Culver, D.A. (2016). Sarcoidosis of the Upper and Lower Airways. In: Mehta, A., Jain, P., Gildea, T. (eds) Diseases of the Central Airways. Respiratory Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-29830-6_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-29830-6_2

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-29828-3

  • Online ISBN: 978-3-319-29830-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation