ATS GUIDELINES Bundle

Sarcoidosis

American Thoracic Society Quick-Reference GUIDELINES Apps

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13 Organic exposure, small poorly formed interstitial granulomas in interstitium, prominent lymphocytic infiltrates, chronic inflammatory infiltrates accentuated around bronchioles Aerosolized water exposure, MAC cultured from sputum, lung or hot tub, large well- formed granulomas in bronchiole lumens Inorganic exposure history Usually nonnecrotizing granulomas. Drug exposure history essential. See www.pneumotox.com for full list Serum ACE elevated in many patients; particles found on biopsy; perivascular granulomas Central lipid vacuole; ingestion of mineral oil or hepatic steatosis Multisystemic; well formed, usually nonnecrotic granulomas Granulomatous pneumonitis with necrosis and vasculitis; multiple necrotic lung nodules Cervical lymphadenopathy and low-grade fever. Granulomas are not found, although necrotic areas with histiocytes are present Lacks progressive lung parenchymal disease, elevated serum calcium, 1,25-dihydroxyvitamin D, and ACE Associated with asthma and Aspergillus infection in 50%. Necrotizing granulomas exclusively in bronchi and bronchioles

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