2010 Volume 32 Issue 6 Pages 534-540
Background. Sarcoidosis with pleural involvement is rare. We report a case of sarcoidosis involving the bronchi, lungs, and pleura which developed into pneumothorax diagnosed by video-assisted thoracoscopic surgery. Case. A 27-year-old man visited a local physician because of prolonged dry cough. A chest X-ray film showed bilateral diffuse pulmonary infiltrates, and he was referred to a pulmonologist at our institution. Clinical images, including chest CT and gallium scintigraphy, suggested pulmonary sarcoidosis. A pulmonary function test revealed both obstruction and stenosis. Fiberoptic bronchoscopic examination showed partial or complete obstruction of the peripheral bronchi. Sarcoidosis was clinically diagnosed based on these findings. But steroid treatment would be introduced, soon after diagnosis pneumothorax developed on the left side. He was then referred to a thoracic surgeon. Result. Partial resection of the apex of the left lung, including bulla and nodules were performed by video-assisted thoracoscopic surgery. Thoracoscopic findings showed funiform adhesion and multiple small perforations on the parietal pleura at the apex. Biopsy of the parietal pleura was not performed. Histopathological examination of the resected lung demonstrated non-caseating epithelioid cell granuloma. His pulmonary function improved after surgery and steroid treatment. Conclusion. For pulmonary sarcoidosis which developed into pneumothorax, diagnosis and treatment were simultaneously performed using video-assisted thoracoscopic surgery.