LXVIII Sarcoidosis of the Mucosa of the Respiratory Tract

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Abstract
Of 49 patients with intrathoracic sarcoidosis who underwent bronchoscopy (144 biopsies), 30 or 61% revealed noncaseating epithelioid-cell granulomas in the wall of one or more major bronchi, often without visible gross mucosal abnormality. Multiple random biopsies of normal appearing bronchial mucosa yielded granuloma in 12 of 27 patients or 44%. The highest proportion of endobronchial sarcoidosis was encountered in patients whose chest X-ray exhibited bilateral streaking and nodulation in the mid- and lower-lung fields (60 to 83%). However, a fair proportion of patients in the earlier phase of sarcoidosis with bilateral hilar adenopathy and clear lung fields also showed endobronchial granulomas[long dash]6 of 15 patients (40%). Patients in the chronic phase of pulmonary sarcoidosis with lesions of more than two years'' duration yielded a high proportion of bronchial granulomas; 12 of 18 patients (67%). This frequency of positive findings in the chronic phase makes random bronchoscopic biopsy an important addition to the diagnostic measures employed in late pulmonary sarcoidosis when scalene fat pad biopsy and the Kveim test lose some of their efficiency. Granulomas in the upper respiratory passages in nine patients with generalized sarcoidosis were always associated with local symptoms arising in the nose, pharynx and larynx. Random biopsies of normal appearing nasal mucosa in seven other patients without upper respiratory symptoms failed to detect granulomas.