Forms of sarcoidosis of the lungs. Sarcoidosis of the lungs - causes, diagnosis, symptoms and treatment

Sarcoidosis of the lungs and intrathoracic lymph nodes is a systemic disease inflammatory nature. In sarcoidosis, granulomas form in the tissues. According to the data medical statistics, this pathology is more often diagnosed in middle-aged women.

Causes of Sarcoidosis

Sarcoidosis of the lungs develops against the background of exposure to internal and external factors. Causal factors may be related to:

infection
environmental influence;
heredity;
drug therapy.

If this disease of the lungs and intrathoracic lymph nodes was provoked by an infection, then when they enter the body, the microbes cause an immune response, which consists in the production of antibodies. Antibodies, in turn, circulate in the blood and penetrate into all organs. With prolonged circulation of antibodies in the body, biochemical and cellular processes occur. As a result, cytokines are formed. If a person has a hereditary predisposition, then this process can cause sarcoidosis in him.

The presence of one infection may not always lead to the development of the disease; for this, other factors must be present. So, at risk are people who have had tuberculosis, chlamydia, Lyme disease, stomach ulcers, herpes or rubella.

Scientists have proven that sarcoidosis of the lungs is transmitted by contact. Upon contact with a sick person, the disease can make itself felt in years. In 25-30% of cases, sarcoidosis can be diagnosed in the same family.

External factors play a significant role in the development of the disease. Harmful substances in the air can provoke pathology. Persons who work with dust daily are also at risk. Therefore, miners, rescuers, firefighters or grinders are diagnosed with sarcoidosis of the lungs 2 times more often.

There is a certain trend in the incidence in persons in contact with metals such as gold, aluminum, titanium, cobalt or beryllium. They tend to be more prone to developing sarcoidosis. On hit a large number metal into the body, granulomas are formed in the lungs or intrathoracic lymph nodes (VLNU).

Sarcoidosis can develop due to long-term use some medicines. These drugs include Interferon and antiretroviral drugs.

Symptoms of the disease

The main symptom in sarcoidosis of the lungs and intrathoracic lymph nodes is weakness. It is observed in 50-80% of patients. As a rule, many patients do not pay much attention to this symptom and do not go to the doctor. If not provided in a timely manner health care the disease begins to progress. In severe stages of the development of the disease, weakness causes disturbances in the work of the respiratory system or the heart. Especially acute weakness is felt in the morning.

As a rule, after sleep, patients do not experience a feeling of cheerfulness, strength is not restored overnight, symptoms are added headache And It's a dull pain in the muscles.

IN rare cases one of clinical signs disease may become fever. The patient's body temperature may rise sharply to the level of 39 ° C. Fever indicates that there are acute inflammatory changes in the body. Heat can be observed with inflammation of the parotid lymph nodes.

As the disease progresses, the patient loses weight rapidly. Weight loss is due to a metabolic disorder or chronic inflammatory process. General state the patient is gradually deteriorating. The body weakens and stops absorbing nutrients.

In sarcoidosis, the lymph nodes in the neck are most often inflamed. Depending on the location of the granulomas, the lymph nodes may become inflamed. different groups. When palpated, the nodes are dense, but mobile.

With the defeat of the intrathoracic lymph nodes, granulomas, as a rule, form in the nodes of the mediastinum. The disease manifests itself in the compression of the bronchioles and bronchi as a result of inflamed lymph nodes. In this case, the patient develops shortness of breath, which worsens after physical exertion. To compensate for the supply of oxygen, the bronchi expand, but due to enlarged lymph nodes and granulomas, the volume of air does not increase.

Over time, coughing fits may occur. The patient tries to cough up sputum and mucus, as well as restore patency in respiratory tract. At advanced stages, the cough becomes painful, this is due to the fact that the pleura was involved in the inflammatory process. The lung tissue does not have nerve fibers, but if the granulomas are located close to the pleura, then not only coughing, but also breathing becomes painful. X-rays may show enlargement of intrathoracic lymph nodes.

Traditional treatment

The earlier the diagnosis is made, the more effective the treatment will be. Based on the results of the examination, the doctor prescribes a comprehensive treatment, the main task of which is to improve the quality of life of the patient and eliminate the symptoms of the disease.

Medical therapy involves taking corticosteroids. These drugs give good result at any stage in the development of the disease. The dosage of the medicine is prescribed by the doctor, because large dose the drug can cause softening of the bone tissue and disruption of the metabolic process. If the intrathoracic lymph nodes are affected, doctors prescribe corticosteroids in the form of inhalation.

The patient is also prescribed drugs of the category of glucocorticosteroids. They have a strong anti-inflammatory effect and prevent the development of granulomas. If sarcoidosis is chronic, and the patient has an increase in lymph nodes, then doctors prescribe Methotrexate. This drug stops cell growth and reduces inflammation. The course of treatment lasts at least 3-4 months.

In case of VLLU inflammation, treatment is carried out with Pentoxifylline - it allows you to gradually reduce the dose of corticosteroid drugs and restore the process of oxygen supply to tissues.

Surgical treatment for enlarged VLN today is quite rare, this is due to the complexity and trauma of the operation. When lymph nodes are surgically removed, sarcoid granulomas may re-form. That's why surgical intervention carried out only in the case when sarcoidosis poses a threat to the life of the patient.

Video about sarcoidosis:

Several types of surgery can be performed for sarcoidosis of the lungs and VLN. When defeated lung tissue during the operation, the doctor removes the lung defect, due to this, pressure normalizes and breathing is restored. If, during a disease, the patient has an overgrowth of bronchioles and respiratory failure has appeared, then doctors carry out lung transplant. This operation is rarely performed due to high cost. During the operation, the affected lung is replaced with a healthy donor one. Such an operation, on average, prolongs the life of the patient by 5-7 years.

In the treatment of enlarged VLLU, irradiation shows a good result. For elimination acute symptoms about 3-5 sessions of irradiation are carried out.

Treatment with folk methods

In combination with the main treatment, methods can be used traditional medicine. Doctors recommend treating sarcoidosis with folk remedies only in the early stages of the disease. Before using this or that remedy, you must first consult with your doctor.

With inflammation of the lymph nodes, you can cook herbal collection based on sage, oregano, plantain, mountaineer, marshmallow root and calendula. To prepare the recipe, you need to take each herb 1 tbsp. l. 2 tbsp. l. crushed herbal mixture pour 400 ml of boiling water. The infusion should stand for 30-50 minutes. Take 1/3 cup 3 times a day for a month.

Video about sarcoidosis:

If in the initial stage of sarcoidosis there is a slight increase in lymph nodes in the neck, armpits or elbows, then the disease can be treated with vodka and oil. Mix 30 g of vodka or alcohol with 30 g of linseed oil. The medicine should stand for a day. Drink 1 time per day for ½ tsp.

Sarcoidosis 3 degrees- parenchymal disease without enlargement of intrathoracic lymph nodes.

Characterized growth in the lungs connective tissue.

Etiology sarcoidosis is still remains unknown. There are such versions as heredity, environmental influences.

Pathogenesis and symptoms of sarcoidosis grade 3

As already mentioned, with grade 3 sarcoidosis, there is an overgrowth of connective tissue in the lungs, that is fibrosis. However, in the lesions impaired function of gas exchange leading to respiratory failure and emphysema. Due to fibrosis intact lung tissue begins to stretch and form air cavities.

Photo 1. Lung tissue in advanced sarcoidosis showing characteristic granulomas inside.

In medicine, this phenomenon is called "honeycomb lung". Besides, third stage sarcoidosis lung tissue infiltration and dissemination are characteristic.

Leading symptoms sarcoidosis 3 degrees:

Dyspnea: initially during exercise, then at rest (as the disease progresses).
Skin cyanosis and pallor due to inadequate oxygen supply.
Weakness and fatigue.
Cough(often dry, but sometimes with slight sputum production).
Decreased appetite and as a result weight loss.

Diagnostics

Diagnosis of sarcoidosis is greatly complicated by its similarity to other diseases. To rule out tuberculosis Mantoux test. Next, it takes general blood analysis with leukocytosis. Radiography allows you to identify lesions and cavities of the lung tissue.

With help CT and MRI detect the presence of accumulations immune cells- granuloma. To clarify the diagnosis of grade 3 sarcoidosis, biopsy flushing water is taken from the lungs.

What is the treatment for this stage?

At stages 1 and 2 sarcoidosis in 70% of cases, granulomas go away on their own without any therapy, but at 3 stages this probability is reduced. up to 30%. Treatment of the disease is carried out together with secondary ailments (at least respiratory failure). For the treatment of grade 3 sarcoidosis, glucocorticoids, anti-inflammatory drugs, antioxidants, sometimes used cytostatics.

Photo 2. The drug from the class of glucocorticoids Prednisolone in 1 ml ampoules, manufacturer Elfa.

For prevention osteoporosis prescribe bisphosphonates. Medications are taken during several years to prevent relapse. It is also possible to use oxygen therapy(treatment air environment With high blood pressure oxygen). The overgrown connective tissue will not be able to become pulmonary again with any treatment. For this reason, therapy must be started on time. However, the opinions of scientists differ: some believe that treatment should not be carried out before the appearance of complaints for the possibility of self-remission, others recommend the immediate use of medications even before the onset of symptoms.

Additional drugs

They are also appointed additional drugs:

to prevent the addition of a bacterial infection as a secondary disease, prescribe antibiotics a wide range actions;
to prevent joining viral infection as a secondary disease is prescribed antiviral drugs;
diuretics drugs are prescribed for stagnation of blood in the lungs to reduce hypertension;
prescribed to maintain immunity vitamin complex.

In severe pulmonary fibrosis and risk of bleeding, may be recommended surgery, lung transplantation.

Important! In the treatment of sarcoidosis necessary constant surveillance doctor using chest x-ray and spirometry.

Forecast for life

Prognosis for stage 3 sarcoidosis not very favorable, depending on the degree of proliferation of connective tissue. In any case, there are already changes in the lungs that are incompatible with their full functioning.

Death can occur with the development of severe complications- in particular, respiratory failure.

Beck's disease (sarcoidosis) is commonly referred to as a multisystem pathology that affects different organs. Of the systems, it primarily affects the respiratory system. The precipitating factors are unknown. Also, the reasons that contribute to the fact that lung sarcoidosis in some patients begins to regress have not been clarified.

This disease is not infectious. Hormone therapy is considered the main tactic for treating the disease.

One of the brightest diagnostic signs a disease such as sarcoidosis, it is considered the detection of granulomas in the affected tissues (in particular, in the lungs). They are foci of inflammation. different sizes but always limited. Granulomas look under microscopy as dense nodules with a characteristic structure. Nodular formation is a consequence of inflammation and its main manifestation.

Nodules are mainly represented by:

Multinucleated giant cells.
T-lymphocytes.
macrophages.

Moreover, the latter are not found at all stages of the disease. Such cells are typical for granulomatosis.

Classification

There are several classification criteria for sarcoidosis. Most frequent forms the described pathology is:

Defeat lymphoid tissue.
Sarcoidosis of the lungs.
Changes in the tissues of the liver and spleen.

Much less often, Beck's sarcoidosis (or rather Besnier-Böck's disease) affects skeletal system, organs of vision, skin and other systems of the human body. For example, sarcoidosis of the heart is one of the rare types of pathology. The generalized form of the disease is more often diagnosed. In this case, damage to the lungs and another organ is combined.

by clinic and radiological signs taken to highlight:

Only the lungs without the involvement of lymph nodes in the process with the development of irreversible fibrotic changes in the tissues of the organ.
Sarcoidosis of the intrathoracic lymph nodes (ITLN) when lung tissue is not affected.
There are frequent cases of diagnosing sarcoidosis VLN when the mediastinum, roots and lung parenchyma are affected.
Damage to other systems and respiratory organs.
Multiple damage not only to organs, but also to other systems.

The classification of such a disease as sarcoidosis of the lungs suggests a staging of the development of the process, which is consistent with the results of an x-ray examination:

At the initial stage, there is often an asymmetric, but bilateral lesion of the lymph nodes of the chest.
In the second phase of the development of the disease, the pathology spreads to the lung tissue in the form of miliary (millet-like) foci. Grade 2 sarcoidosis is characterized by infiltration of the lung tissue and VLN.
At the third stage of the disease, fibrotic changes in lung tissues are noticeable, while VLN is not increased. Develops pneumosclerosis and emphysema with the formation of large (confluent) granulomatous foci.

Depending on the speed at which pathological changes in the patient's body, the nature of the pathology is usually divided into:

Chronic.
Abortive.
Progressive
Delayed.

The pathological process itself can be divided into 3 phases:

active/exacerbations.
stabilization.
Reverse development / regression / remission.

After suffering an exacerbation of the disease and stabilization of the condition, the patient in some cases has pneumosclerosis and emphysema, pleurisy, fibrosis of the hilar zone of the lung, calcification of the intrathoracic lymph nodes.

At the initial stage of the pathological process, the radiograph may not reveal changes.

Etiology

The causal relationship of a disease such as sarcoidosis with any external factors has not been installed. Actually, the ability to be transmitted from person to person has not been proven. However, familial cases have been reported. This can be explained:

Heredity.
Living in identical conditions that adversely affect the health of the whole family.

Modern medicine considers several hypotheses about the causality of sarcoidosis as a disease:

Medical.
Contact.
Hereditary.
Infectious.
Influence of exogenous harmful factors(dust with an admixture of some materials, for example, beryllium, gold, titanium, lead, zirconium and others).

Adherents of the first hypothesis associate Beck's disease with taking certain medications for a long period of time (interferons and some antiviral agents). They prove their case by appealing to the fact that the rejection of these drugs leads to a regression of the disease. But it was not possible to reliably confirm or deny it.

The contact theory suggests that there is a possibility of infection when communicating with the affected tissues of a sick person. Such contact is found in at least a quarter of cases of clinically confirmed diagnosis of sarcoidosis. The possibility of such transmission of the disease is accepted by most researchers involved in the study of this problem.

The hereditary hypothesis insists that some individuals have a predisposition to this species pathology. However, to identify common causal factor for all patients, even within the same family, is not yet possible.

The infectious theory states that patients with a history of some viral or bacterial diseases, are more likely to "get" sarcoidosis of the lungs and other organs. To such infectious pathologies include:

Gastritis and stomach ulcers caused by Helicobacter pylori.
Chlamydial pneumonia.
Tuberculosis.
Borreliosis (Lyme disease).
Propionibacterium acne.
Rubella, hepatitis C, herpesviruses, adenoviruses of various types.

Pathology of the lungs and intrathoracic lymph nodes is much more common in people involved in industries associated with the inhalation of harmful gases and dust (miners, firefighters).

Each of these theories describes probable causes which may result in liver, kidney, skin, or lung sarcoidosis. But even in the presence of all the described factors, the disease may not occur.

None of the proposed versions is completely satisfactory. Therefore, the disease refers to pathologies with an unexplained etiology.

signs

The symptoms of sarcoidosis largely depend on the location of its focus. TO common features This disease includes:

Weakness.
An increase in body temperature up to 38 C.
Decrease in body weight.
Enlarged lymph nodes.

Moreover, weakness for a long period is the only sign developing pathology, and then other symptoms of the disease join. Weight loss is usually seen with serious violations in the work of internal organs associated with the pathological process. With liver damage, the patient is worried about discomfort in the right hypochondrium, slight jaundice may be noted.

Signs of damage to the respiratory system

Pathology debuts asymptomatically, because granulomas do not grow quickly. With the course of the pathological process, the symptoms of sarcoidosis of the lungs manifest themselves in the form of:

Reflex cough without expectoration.
Shortness of breath.
Pain and strange sounds in the chest.
Sleep disorders.
Sweating.

If the cough is accompanied by sputum discharge, this indicates the addition of a bacterial infection.

On initial stage coughing is not a problem for the patient. But with the involvement of the pleura in the pathological process, the cough becomes painful, like a deep breath.

Shortness of breath is characteristic of the course of the disease with enlarged lymph nodes. It intensifies as a result of the load. Since the body needs more oxygen during physical effort, the lung tissues affected by granulomas and squeezed by the lymph nodes cannot close the body's need for oxygen.

Signs of damage to lymphoid tissue

Peripheral lymph nodes are affected quite often. This is expressed by swelling of one or a whole group of nodes. The disease must be differentiated from lymphadenopathy, in which the changes are functional in nature and are not associated with the formation of granulomas.

With this pathology, the lymph nodes can be affected:

Neck.
Breast.
Inguinal and axillary.
limbs.

The latter are rarely involved in the process. Usually with damage to the lymphoid tissue, damage to the spleen is noted. In addition to discomfort in the left hypochondrium, the patient is rarely bothered by any other manifestations of the disease.

Signs of skin lesions

What is sarcoidosis of the skin and what it looks like is easy to understand. Skin changes can be reactive, that is, associated with the formation of granulomas during internal organs, on it you can see only the reaction of the body to the disease. And these manifestations can be associated with the actual growth of granulomas in the thickness of the skin.

The main features in this case are:

polymorphic rashes.
Peeling.
Change in pigmentation.
Hair loss.
The appearance of scars and ulcers.

Reactive manifestations are presented in the clinic of the disease. nodular erythema. They are usually accompanied by a triad of signs:

Enlargement of the lymph nodes of the mediastinum.
The defeat of several (up to 5) large joints.
Localization of erythematous rashes in the leg area.

Usually reactive manifestations tend to regress within a few weeks. Actually, granulomatous skin lesions are much less common than erythema nodosum.

Signs of heart damage

Myocardial function can suffer both with damage to the heart muscle or septa of the heart, and with damage to the lymph nodes and lungs. The main complaints of patients are:

Arrhythmias.
Pain behind the sternum.
Loss of consciousness.
Edema of the extremities.
shortness of breath and fatigue during physical activity.
Paleness of the skin.

At any stage of the described lung disease, there is pulmonary hypertension. This leads to an increase in the load on the heart (right ventricle) and the appearance of "heart" symptoms.

Signs of the development of the disease in an atypical zone

These symptoms are very diverse and depend on which organs are involved in the process. For example:

When bone tissue is damaged, fractures become more frequent.
If the process affects the larynx, the patient may lose his voice.
With the defeat of the nasal passages, bleeding from the nose becomes more frequent and there is constant congestion.
If sarcoidosis has affected the hearing organs, complaints of pain and ringing in the ears, coordinating disorders are typical.
With muscle disease, patients complain of pain in the affected limb, its weakness and inflammatory changes at the site of the focus.
With the growth of granulomas in the tissues of the joint (joints), the clinic mimics rheumatoid arthritis.
The growth of granulomas in the kidneys is extremely rare. The process itself is accompanied by a violation of their filtering function and inflammation. Sarcoidosis of any organ increases the risk of kidney stones.
The growth of the described benign formations can also affect brain structures. Symptoms depend on the affected area. These may be visual, hearing, touch or smell impairments. There are convulsive and meningeal symptoms.
With damage to the peripheral part nervous system there may be paresis and paralysis in the area innervated by the affected nerve.
If the pituitary gland is affected, endocrine disorders are possible.
Defeat salivary glands leads to dysfunction.
The pathological process in the intestine leads to painful constipation and diarrhea, replacing each other. There is no blood in the stool. Due to a violation of the absorption process, a person loses weight, his skin and its appendages become dry and weak.
Nausea and loss of appetite accompany the growth of granulomas in the stomach.
Pathology of the organ of vision can cause a significant decrease in vision and blindness.

Diagnostics

As diagnostic measures, an analysis of the symptoms of the disease is used, as well as hardware and instrumental examination sick. The gold standard for diagnosing sarcoidosis is:

X-ray study.
Histology.
Clinic.

A whole arsenal of studies can be involved, from CT, MRI, ultrasound and ending with methods that allow to determine functional state lungs (spirometry), heart (ECG, EchoEG), skeletal muscles (EMG), bronchoscopy. An examination by an endocrinologist, ophthalmologist, otolaryngologist, pulmonologist, gastroenterologist, cardiologist may be necessary.

Diagnosis of sarcoidosis involves identifying characteristic changes in the patient's blood (increased levels of ACE, calcium, copper, TNF-α). The latter indicator was revealed relatively recently, it is involved in many pathological processes.

In this disease, tuberculin test(Mantoux) to differentiate the diagnosis from tuberculosis and the Kveim-Silzbach test (this is a kind of "mantoux" for sarcoidosis).

Therapy

Medical supplies, pills and capsules

How to treat this unpleasant disease? Firstly, doctors have to take into account the fact that the pathological process can regress. Therefore, at the first stage, before treating sarcoidosis, patients are observed for about six months in order to identify trends and determine the treatment.

At mild degree disease, medical intervention is not carried out. In this situation, the risk of complications resulting from intensive treatment is higher than the risk of developing the disease itself.

Immediate intervention is carried out only in case of a rapid increase in symptoms and serious condition sick. The arsenal that doctors can use is quite rich in methods:

Medication (general and local measures).
Surgical.
Physiotherapy.
Diet therapy.
Irradiation.

Treatment of pulmonary sarcoidosis involves the use of following groups drugs:

Hormones (Hydrocortisone, Dexamethasone, Prednisolone) are first-line drugs.
Non-hormonal anti-inflammatory (Meloxicam, Aspirin, Ibuprofen, Diclofenac and others).
Vitamin preparations containing A and E-vitamins (as antioxidants).
Immunosuppressants (Azathioprine, Delagil, Chloroquine).

Sarcoidosis of the lung treatment requires hormones. Assign immediately in a large (shock) dose, followed by a decrease in a single amount. Topical treatment is usually used for skin forms of the disease and for eye damage. Surgical intervention is required for lung collapse, in case of lung transplantation, removal of the spleen, or stopping gastric or intestinal bleeding.

There is no specific diet for this category of patients. Refusal of fast food is welcome. Coursework is practiced in medical institutions therapeutic fasting under the supervision of a physician. Independent application this method is not recommended.

After the onset of remission, patients should be registered at the dispensary for at least 2 years.

Sarcoidosis of the lymph nodes is a chronic systemic pathology characterized by the formation of inflammatory granulomas in the lymph nodes. In most cases, the disease develops in the lung parenchyma, but there is a clinical variant of the disease in which the lymph nodes are affected. international organization sarcoidosis is considered to be one of the varieties of systemic pathology. ICD code 10 D86.

Comparing the statistical data, it was found that such a diagnosis is established preferentially for women of average age. age category. Breastfeeding mothers are also at risk for morbidity. In a chronic course, relapse may develop in the postpartum period.

Classification of sarcoidosis

There are several types of classification depending on the severity, phase of the course, and clinical symptoms, given this, the sarcoma of the lymph nodes is subdivided:

Depending on the stage of the disease:

the first stage is exclusively sarcoidosis of the intrathoracic lymph nodes;
damage to VLLU and parenchymal tissue of the lungs;
the formation of fibrotic changes, the spread of the lesion to the lymph nodes of the mediastinum.

Depending on the clinical phase and the presence specific complications distinguish such phases of the disease:

active;
stable;
reversible.

The clinical course can be recurrent, with a positive or progressive prognosis.

Why does this disease occur?

To date, the exact cause of the development of the disease has not been fully studied. Taking into account the characteristic anamnesis, complaints and objective examination of patients, theories were developed, according to which it is supposed true reason development. Differential diagnosis can also help in identifying the etiological factor.

Infection theory

The infectious theory is based on the fact that the activation of the disease can occur against the background of infection of any bacterial infection provided that there is a predisposition to sarcoidosis. From the pathogenesis it is known that when an infection enters the body of a bacterium, an inflammatory reaction develops with activation cellular immunity and specific antibodies are formed.

The prolonged course of the inflammatory process leads to the accumulation of microorganisms and, as a result, pathology develops in the lymph nodes.

The theory of disease transmission through contact with the sick

In order to confirm this theory, an observation was made of a patient with sarcoidosis and members of his environment. The results of this study showed that 40% contact persons the disease developed. Cases in transplantology have also been registered, when they were transplanted donor organs from a sick person to a healthy one.

Impact of environmental factors

A colossal role in the development of the disease is assigned to the impact on the human body of harmful environmental factors. The most pathogenic for humans is industrial dust that enters the lungs. by respiratory route, and provokes inflammatory reactions. Occupations in contact with dust pollutants include: rescuers, miners, grinders and others.

hereditary theory

The hereditary theory is based on the presence in humans of a particle of a defective gene. If there is such hereditary pathology any adverse factors affecting the external environment can provoke the development of sarcoidosis of the lymph nodes.

Theory associated with the negative effects of drugs

The drug theory implies the development of the disease against the background of long-term use drugs for the treatment of chronic diseases. Lymph node involvement appears as by-effect from taking drugs. According to the results of monitoring such patients, it was found that the progression of the disease slows down against the background of discontinuation of drugs.

Drugs that provoke an exacerbation of the disease include interferons and antiretroviral agents.

How does the disease manifest itself?

Sarcoidosis in the lymph nodes can occur with both severe clinical manifestations, and without them. The asymptomatic course most often occurs when the lymph nodes in the chest area are affected, while the process does not extend to other organs and systems. The disease is discovered by chance, during the passage of a routine fluorographic study.

Most often, the pathology develops gradually with common clinical manifestations:

fatigue even with little physical activity;
severe general weakness;
cough reflex, which is accompanied by shortness of breath;
pain in the spine.

The above symptoms begin to disappear 2 weeks after their development. With damage to the lung tissue with the development of fibrosis, prediction for recovery is difficult, since the patient has increasing symptoms of respiratory and cardiovascular insufficiency.
Acute leakage Sarcoidosis is extremely rare. The patient's body temperature suddenly rises to a feverish state.

Inflamed nodes can be seen on the skin, well palpable and rising above its surface. In the pathological process may be involved large joints with a preferred symmetrical lesion. The prognosis for recovery in this course of the disease depends entirely on the tactics of conducting medical measures.

What complications can develop?

The disease itself does not pose a particular danger to human life, but specific complications should be avoided, which manifest themselves in the form of:

compression variant of lung atelectasis;
damage to a blood vessel and the development of internal bleeding;
chronic course of inflammatory processes in the lung parenchyma and bronchial tree;
formation of stones in the area renal pelvis, ureters and bladder;
violations of the rhythm and conduction of the heart;
oppression of functioning central departments nervous system.

Differentiation of sarcoidosis is necessary with a variety of infectious and oncological diseases, one of the symptoms of which is an increase and inflammation of the lymph nodes.

Diagnosis of the disease

To date, there is a specially developed scheme for examining a patient and conducting the necessary instrumental diagnostic methods:

Careful examination and questioning of the patient at an outpatient appointment.
Are common clinical researches blood.
Biopsy of a lymph node.
X-ray methods are necessary to determine the localization of the affected nodes. By using this method differential diagnosis with oncological diseases is carried out.
Computed and magnetic resonance imaging are performed for the purpose of differential diagnosis with malignant oncological diseases.

Carrying out therapeutic measures

Modern treatment of patients with sarcoidosis in the lymph nodes is carried out using the following methods:

Medical treatment carried out using steroid hormones. The drug is administered only under conditions medical institution. Hormonal agents can be administered parenterally, orally, or used externally.
Surgical intervention carried out with irreversible structural changes lymphoid nodes and parenchymal lung tissue.

To achieve the stage of remission of the disease, are widely used beam methods treatment.
dietary treatment implies an increase in consumption throughout the day of products containing proteins, vitamins and minerals.

At proper conduct therapeutic measures and adherence by the patient to the recommendations of the doctor, recovery occurs much faster and without complications.

Sarcoidosis is a rare systemic diseases With chronic course. characteristic manifestation pathology - the formation in the altered tissues of granulomas - limited inflammatory foci, which are compacted large nodules. The disease affects mainly the lungs, but the process can affect lymphatic system, liver, spleen, sometimes extends to bones, skin, eyes and other organs. Treatment of sarcoidosis of the lungs is carried out by a long course hormone therapy, in the absence of measures, respiratory function is impaired.

It is believed that the pathology does not pose an infectious danger. Sarcoidosis predominantly affects humans. young age and middle-aged, in women the statistics are higher by 3-16%. African Americans are 10 to 17 times more likely to suffer from the disease than whites on the continent. In Indians and Eskimos, the disease is diagnosed extremely rarely. In Russia, there are 20 cases per 100,000 people.

The pathology was described at different times by the scientists Besnier, Beck and Schaumann, therefore sarcoidosis was previously called Besnier-Beck-Schaumann disease, or Beck's disease for short. It is characterized by a multi-organ course, accompanied by stages of exacerbations and remissions. When the disease develops in the lungs, sarcoidosis affects the tissue of the alveoli, causing interstitial inflammation vascular wall(pulmonitis) or alveolitis. Later, the formation of epithelioid granulomas occurs with the presence of blood vessels in the peribronchial and subpleural parts of the organ. Subsequently, the granulomatous formation resolves or transforms into a vitreous (hyaline) mass, leading to a violation of the ventilation function of the lungs. Enlarged lymph nodes compress the walls of the bronchi, which causes a deterioration in the air conduction of the area and the formation of airless zones (atelectasis). What sarcoidosis looks like can be seen in the photo.

Despite multiple studies, the causes of pulmonary sarcoidosis are unknown. Several concepts have been put forward about the occurrence of the disease:

Virologists associate the formation of the inflammatory process with inhalation pathogenic microorganisms: viruses and herpesviruses, atypical mycobacteria (Koch's wand), as well as fungi and mycoplasmas.
The familial lesion data suggests a genetic theory of the development of the disease.
Other researchers insist on allergic origin sarcoidosis, when an immune response occurs to the introduction external stimuli: toxic substances, dust, bacteria. The internal factors of the pathological process include autoimmune reactions.

For the origin of the disease is important and professional activity person. Sarcoidosis is most commonly diagnosed in firefighters, workers chemical industry, postal employees, sailors, as well as millers or agricultural workers. That is, in people directly associated with toxins or infectious agents.

It is believed that sarcoidosis has a polyetiological nature and its appearance is due to genetic, morphological and biochemical factors.

Local outbreaks of pathology or cases of infection in a professional environment, when contacting people fall ill, indicate that a pathogen is present or the disease is infectious.

Typical symptoms of pathology

With sarcodiasis of the lungs, symptoms may not appear for a long time. This is associated with a weak innervation of the lung tissues, therefore, with the growth of granulomas, the nerve endings hasn't happened for a while. As the process progresses, signs of damage respiratory organs become expressed. At the beginning of the disease, the general symptoms characteristic of the inflammatory process are disturbing:

weakness;
fatigue;
temperature rise to subfebrile indicators;
loss of appetite;
subsequently dry cough joins;
chest pain;
shortness of breath physical stress later on walking;
arthralgia - joint pain.

With fibrotic changes in the lungs, the vital capacity of the organs decreases, and respiratory and heart failure increases. Diffuse cyanosis develops, increasing with physical activity, shortness of breath disturbs the patient at rest. It is not uncommon for a patient to have symptoms drum fingers when the tips of the phalanges thicken.

Percussion determines the high standing of the lower border of the lungs, while inhaling and exhaling, there is a limitation of the displacement of the organ. In the middle and lower sections when listening, moist crackling rales are detected.

Existing stages of the disease

The classification of pulmonary sarcoidosis is based on data x-ray examination. The stages of the course of the disease are distinguished:

First or initial. Lymph glandular intrathoracic form, in which bronchopulmonary LUs (lymph nodes) are symmetrically affected on both sides. Sometimes changes are noted in the tracheobronchial LU, rarely damage is detected in the paratracheal LU. There may be disturbances in the lymphatic structures localized in the branching of the bronchi of the 2nd order along the length of the lower trunk pulmonary artery on the right side.
The second is mediastinal-pulmonary. The stage is characterized by damage to the intrathoracic LU (VLLU). The process spreads to the middle and lower parts of the organ, lung tissues are affected by the small-focal and reticular type.
The pulmonary form occurs in stage 3 of the disease. Changes in the tissues of the organs are pronounced, there is no increase in VLN. Dense dissemination is noted in the middle sections, there is a replacement of lung tissue with connective tissue (pneumosclerosis). There is also an accumulation of air in the distal space of the terminal bronchioles due to destructive changes affecting the alveolar walls (emphysema).

According to the manifestations, the disease is divided into periods: active phase- exacerbation of sarcoidosis, the next - stabilization and regression stage, attenuation. The reverse process in some cases is distinguished by the resorption of granulomas or their calcification. According to the rate of development of changes in the lungs, sarcoidosis is divided into:

to progressive;
to slow;
on abortive, that is, suspending the course;
to chronic.

After treatment or resorption of granulomas, the consequences of the disease can be pneumosclerosis, pleurisy, emphysema, tissue fibrosis at the roots of the lungs with or without decalcification of the VLH.

Diagnosis and treatment

To confirm respiratory sarcoidosis, a set of measures is carried out to identify pathology and differentiate signs from other diseases similar in symptoms: tuberculosis, lymphogranulomatosis, fibrosing alveolitis. What methods are used:

X-ray examination of the lungs reveals changes in the organs. The images show a decrease in the transparency of the lung tissue and lymphadenopathy, the areas can be mirrored or with pronounced asymmetry. On late stages are found focal changes, fibrosis, emphysema or tissue cirrhosis.
With insufficient information content of radiography, an MRI or CT scan of the lungs is prescribed.
Bronchoscopy shows vasodilation in the lower sections of the bronchi, sarcoidosis changes in their mucosa, characterized by plaques or warty growths. Signs of atrophic bronchitis and an increase in the LU are observed at the bifurcation site.
Transbronchial biopsy or mediastinoscopy allows you to get a part of the biopsy for research, excludes an erroneous diagnosis by 80–95%. Segments of epithelioid granuloma are found in the tissues without manifestations of necrotization of the perifocal inflammatory process.
A blood test in the acute form indicates an increase in angiotensin-converting enzyme, as well as an increase in ESR, leukocytes, eosinophils, monocytes and lymphocytes.

The Kveim reaction is manifested a positive result in the form of redness on the introduction of sarcoid antigen under the skin. This method of research is rarely carried out due to the complexity and danger of introducing an infection.

Preparations

Revealed sarcoidosis of the respiratory system in most cases is accompanied by remission, therefore, the development of the disease is first monitored for six months or 8 months. It is required to treat the pathology when the disease progresses, acquires acute course, intrathoracic LUs are affected, dissemination in lung tissues is observed. Also, therapy is indicated for complex and generalized manifestations of the disease. Sarcoidosis is treated:

Steroid hormones, course duration - at least 3-6 months. The corticosteroid "Prednisolone" or similar drugs are used, improvement occurs in 80% of cases. The therapy regimen involves daily administration of the drug at a dose of 0.5-1 mg / kg for 3 months. Further, the dosage is reduced to 10-15 mg, the course of maintenance treatment takes place within 6 months or a year.
When adverse reactions, escalate comorbidities, hormones are prescribed in a course with interruptions of 1-2 days.
If insensitivity to steroids is detected, use alternative drugs against cancerous tumors- Methotrexate, Cyclophosphamide.
Possible complex therapy within 4-6 months: "Prednisolone" or "Dexamethasone" alternate with the use of non-steroidal anti-inflammatory drugs - "Diclofenac" or "Indomethacin".
IN initial stages disease, the use of corticosteroids ("Fluticasone") in the form of inhalations is allowed.

At the same time, antioxidant drugs and vitamins C, D, E, immunosuppressants and physiotherapy are prescribed.

Folk remedies

On early stage pathology development application folk remedies for the treatment of sarcoidosis of the lungs contributes to the remission of the disease. What recipes are suitable:

Propolis (20 g) is crushed and infused in 125 ml of vodka in a dark glass container. Take 60 minutes before meals three times a day, 15 or 20 drops, diluted in half a glass of water.
Vodka mixed with unrefined oil sunflower 1:1, three times a day, take a tablespoon before meals. The course of treatment is 10 days, then - a five-day pause. This is repeated 3 times.
Ginseng or radiol rose tincture is drunk in the morning and evening, 20–25 drops each, the duration of the course is at least 15–20 days.
To relieve inflammation and resorption of granules, thyme infused with honey is used. fresh product beekeeping (250 ml) mixed with the plant, if necessary, add water (50 ml). The composition is infused for 15 days in the dark. The infusion is filtered, drink a spoonful in the morning and evening.

Antioxidants, saponins, flavonoids, which are contained in birch sap, also help to treat the disease. Juice is drunk in combination with milk (1:1) in half a glass daily.

Cannot be used to treat cough badger fat: This popular remedy worsens the patient's condition with sarcoidosis.

With sarcoidosis, a properly selected diet is of no small importance. It is especially important to follow a diet during hormone therapy: this helps to avoid complications in the future. Organize the diet should be correct:

Since sarcoidosis is accompanied by an inflammatory process, it is necessary to reduce carbohydrate intake, as organic matter contribute to its development. Reduce the amount of sugar, sweets, flour products, exclude carbonated drinks.
It is forbidden to include smoked meats, pickles, spices in the diet. If it is difficult to do without spicy dishes, it is allowed to eat garlic or raw onions.
With sarcoidosis, the calcium content in the blood increases, there is a risk of formation of stones in urinary tract. Therefore, the consumption of dairy products is reduced to a minimum. Limited use of butter is allowed.
Alcohol in any quantity and dosage is not allowed.

It is recommended to eat more fruits, berries and raw vegetables: antioxidants, vitamins and valuable elements in their composition help fight the disease. The intake of potassium is especially important (these are bananas, potatoes, dried fruits, nuts). It is necessary to include proteins in the diet: lean meats, fish dishes, eggs. The intake of non-animal protein is provided by legumes, vegetable oils. The use of low-fat milk and cottage cheese is limited.

Prognosis for sarcoidosis of the lungs

In pulmonary sarcodiasis, the disease is characterized by a predominantly benign course. The prognosis is favorable for patients in whom the pathology has not acquired a common form. What the statistics say:

60% of patients are asymptomatic;
in 30% of patients, exacerbation ends with spontaneous remission;
with changes only in the lung tissue or lymph nodes after 5 years, 75% of people recover;
relapses of the disease occur in half of the cases;
in Europe, recovery is observed in almost 90% of patients.

The chronic form of the disease with fibrotic changes in the tissues is observed in a third of patients, sometimes there is a clear respiratory failure. Extensive damage to the lungs with impaired alveolar ventilation leads to pathology of the myocardium, the spread of the disease to other organs, the deposition of calcareous growths in the kidneys, inflammation choroid eye (uveitis) and hypercalcemia. Eye damage can result in loss of vision. Rarely (5%) with generalized changes, the lack of treatment leads to the death of the patient.

The disease develops unpredictably, it is noted that the prognosis in patients with dark skin less favorable. Spontaneous manifestation of an acute form often indicates speedy recovery. The appearance of shortness of breath and skin lesions indicate the likelihood of a prolonged course of the disease.

In order to prevent exacerbations of the disease, it is important to abandon bad habits, lead correct image life. It is necessary to eliminate the effect on the body chemical substances and toxins, gases and dusts that adversely affect respiratory system. To prevent the formation of kidney stones, a balanced diet should be organized.