C28. Mediastinoscopia no diagnóstico de sarcoidose

Sarcoidosis is a multysistem granulomatous disease of unknown aetiology that afects several organs, more frequently the lung and the intrathoracic lymph nodes. It is histologically characterized by the presence of noncaseating epithelioid cell granulomas in different stages of development.The authors evaluated the patients submitted to mediastinoscopy in the period of 2000-2002 with lymph node biopsy compatible with Sarcoidosis. They reviewed the diagnostic procedures accomplished prior to mediastinoscopy, in order to understand why the procedures performed until then, had not been enough for the diagnosis, attempting to avoid mediastinoscopy when possible, an invasive procedure with relevant costs.141 mediastinoscopies were performed in this period, 56 of them histologically compatible with Sarcoidosis. The mean age of the patients was 42,9+15,7 (16-70). 30 were male and 26 female. The predominant symptoms were shortness of breath and nonproductive cough. Chest radiograph abnormalities found, were mediastinal enlargement in 85,7% of all the patients, hilar adenopathy in 64,3% and pulmonary infiltrates in 12,5%. CT scan of the thorax showed hilar adenopathy in 89,3% of all patients, mediastinal adenopathy in 98,4,3% and pulmonary infiltrates in 23,2%.13 patients initiated systemic corticosteroid therapy before histological diagnosis. Of the 51 patients with macroscopic description of adenopathy, 31 patients presented with typical sarcoid adenopathy.ACE level determination was done in only 9 patients. Determination of diffusion capacity of CO (TLCO) was accomplished in only 3 patients and Gallium 67 scan in 8 patients. Bronchoalveolar lavage (BAL) was accomplished in 8 patients, with medium CD4/CD8 ratio of 7,35. Transbronchial biopsies were accomplished in 7 patients, with only one of them diagnostic for Sarcoidosis. Minor complications occurred in only 2 patients submitted to mediastinoscopy, which were incisional heamorrage.Conclusions: The present review confirmed the greater sensitivity of CT scan in relation to chest radiograph in detecting hilar and mediastinal adenopathy and pulmonary infiltrates. DLCO determination, flexible bronchoscopy with BAL and transbronchial biopsies were underused. Transbronchial biopsies diagnostic sensibility was very low in this series. As most of the patients were asymptomatic and in stage I, mediastinoscopy could have been avoided or postponed in some patients, monitoring clinical and imagiological evolution. A greater number of diagnostic procedures could have been accomplished before mediastinoscopy, meaningly flexible bronchoscopy with BAL and transbronchial biopsies, probably making mediastinoscopy unnecessary. These results alert for the necessity to expand the knowledge on Sarcoidosis