Letter to the Editor
Sarcoidosis With Neurological Involvement Imitating Multiple Sclerosis: The Importance of Thoracic Imaging
Sarcoidosis con afectación neurológica simulando una esclerosis múltiple: importancia de la imagen torácica
Carmen Picón Serrano
, Sara Escoda Menéndez, Luis Gorospe Sarasúa
Corresponding author
Departamento de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain
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La TC de tórax confirma la presencia de adenopatías mediastínicas de tamaño significativo, una afectación hiliar bilateral (B, reconstrucción coronal con contraste intravenoso) y del parénquima pulmonar (C, imagen axial en ventana de pulmón). 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"Combination of Tracheal Bronchus and Partial Anomalous Pulmonary Venous Return in a Patient With Type 1 Neurofibromatosis and Ipsilateral Vagal Nerve Neurofibroma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "305" "paginaFinal" => "306" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asociación de bronquio traqueal y drenaje venoso pulmonar anómalo parcial en paciente con neurofibromatosis tipo 1 y neurofibroma del nervio vago ipsilateral" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1355 "Ancho" => 1500 "Tamanyo" => 225123 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray showing a mediastinal mass (asterisk) obliterating the pleural-azygos-esophageal line and possible tracheal bronchus (arrows). (B) Minimum intensity projection coronal reconstruction confirming tracheal bronchus. Note the mediastinal mass (asterisk). (C) Axial chest computed tomography (CT) image with intravenous contrast medium, showing anomalous drainage from the right upper lobe pulmonary vein into the superior vena cava (arrows) and the tracheal bronchus (arrowhead). (D) Oblique CT coronal image with intravenous contrast medium showing tracheal bronchus (arrow) and the mediastinal mass (asterisk).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Gorospe Sarasúa, David Saldaña Garrido, Ana María Ayala Carbonero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] 1 => array:2 [ "nombre" => "David" "apellidos" => "Saldaña Garrido" ] 2 => array:2 [ "nombre" => "Ana María" "apellidos" => "Ayala Carbonero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614003342" "doi" => "10.1016/j.arbres.2014.07.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614003342?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915000981?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000006/v1_201505280222/S1579212915000981/v1_201505280222/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Sarcoidosis With Neurological Involvement Imitating Multiple Sclerosis: The Importance of Thoracic Imaging" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "307" "paginaFinal" => "308" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carmen Picón Serrano, Sara Escoda Menéndez, Luis Gorospe Sarasúa" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Carmen" "apellidos" => "Picón Serrano" "email" => array:1 [ 0 => "cpiconserrano@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Sara" "apellidos" => "Escoda Menéndez" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoidosis con afectación neurológica simulando una esclerosis múltiple: importancia de la imagen torácica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 768 "Ancho" => 1500 "Tamanyo" => 147590 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance imaging (MRI) of the head in T2 (A) showing a hyperintense focal lesion in the splenium of the corpus callosum (white arrow). Axial FLAIR image (B) showing a hyperintense focal lesion in the periventricular white matter (white arrow). Both lesions are radiologically non-specific, but in the right clinical context can be indicative of demyelinating disease.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 30-year-old man with no significant history presented in the emergency department in 2007 with loss of vision. A campimetric defect indicative of optic neuritis was confirmed. In view of these findings, corticosteroid treatment (1<span class="elsevierStyleHsp" style=""></span>g/day for 5 days) was administered, and magnetic resonance imaging (MRI) of the head was performed. No radiological studies of the chest were performed during this episode. The head MRI (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) showed focal lesions in the white matter, indicative of demyelinating disease. Since the patient did not meet all the criteria for multiple sclerosis (MS) and had presented no new episodes of neurological symptoms during follow-up, no specific MS treatment was initiated and the patient continued follow-up on an outpatient basis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Several follow-up head MRIs were performed, showing mild disease progression with no clinical repercussions, and the presumed diagnosis of MS was maintained. Six years after this episode, the patient presented with cough and dyspnea. A chest X-ray (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A) showed widened mediastinum, enlarged pulmonary hila, and interstitial involvement. In view of the radiological suspicion of sarcoidosis, a chest CT was performed. Multiple lymphadenopathies in the mediastinum and both pulmonary hila and severe interstitial involvement were confirmed on CT (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Presumed radiological diagnosis was sarcoidosis (stage II), confirmed on histology of a transbronchial biopsy specimen. After treatment began with systemic and inhaled corticosteroids, the patient's clinical and radiological picture improved (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D). A repeat CT of the head showed stabilization of the lesions with respect to the previous examination.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Sarcoidosis is a multisystemic disease of unknown origin that typically affects the lung and intrathoracic lymph nodes, although it can affect the eye, liver, heart, spleen, saliva glands, bone and central nervous system.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> Neurosarcoidosis is uncommon (5% of all patients) and is usually diagnosed by a process of elimination, given the difficulty of obtaining biological samples.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Nevertheless, awareness of this entity may facilitate prompt diagnosis and prevent the development of neurological deficits. Moreover, mistreatment of neurosarcoidosis with interferon (as used in some MS patients) may lead to worsening of the disease.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> The unusual feature of our case is that the patient had been initially diagnosed with probable MS, but 6 years later, in the light of radiological findings in the chest, sarcoidosis was suggested. In view of the lack of clinical activity of the presumed demyelinating disease, clinicians from the Pulmonology, Neurology and Radiology departments agreed to change the initial clinical suspicion of MS to sarcoidosis with neurological involvement. This case demonstrates the complexity of diagnosing this disease in patients whose initial clinical symptoms are neurological, and the importance of including sarcoidosis in the differential diagnosis of demyelinating diseases of the central nervous system.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Picón Serrano C, Escoda Menéndez S, Gorospe Sarasúa L. Sarcoidosis con afectación neurológica simulando una esclerosis múltiple: importancia de la imagen torácica. Arch Bronconeumol. 2015;51:307-308.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 768 "Ancho" => 1500 "Tamanyo" => 147590 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance imaging (MRI) of the head in T2 (A) showing a hyperintense focal lesion in the splenium of the corpus callosum (white arrow). Axial FLAIR image (B) showing a hyperintense focal lesion in the periventricular white matter (white arrow). Both lesions are radiologically non-specific, but in the right clinical context can be indicative of demyelinating disease.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1261 "Ancho" => 1500 "Tamanyo" => 226058 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray (A) showing a widened mediastinum, enlarged pulmonary hila and interstitial involvement. Chest computed tomography confirming presence of large mediastinal lymphadenopathies, and bilateral hilar (B, coronal reconstruction with intravenous contrast medium) and pulmonary parenchymal (C, axial image in lung window) involvement. Chest X-ray (D) obtained 6 months after starting corticosteroid treatment showing normalization of findings.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurosarcoidosis mimicry of multiple sclerosis: clinical, laboratory, and imaging characteristics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.F. Scott" 1 => "K. Yandora" 2 => "L.J. Kunschner" 3 => "C. Schramke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/NRL.0b013e3181b287df" "Revista" => array:6 [ "tituloSerie" => "Neurologist" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "386" "paginaFinal" => "389" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21150390" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple sclerosis mimics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.M. Herndon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Adv Neurol" "fecha" => "2006" "volumen" => "98" "paginaInicial" => "161" "paginaFinal" => "166" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16400833" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Valeyre" 1 => "A. Prasse" 2 => "H. Nunes" 3 => "Y. Uzunhan" 4 => "P.Y. Brillet" 5 => "J. Müller-Quernheim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(13)60680-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2014" "volumen" => "383" "paginaInicial" => "1155" "paginaFinal" => "1167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24090799" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis triggered by interferon-beta treatment of multiple sclerosis: A case report and focused literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.D. Chakravarty" 1 => "M.E. Harris" 2 => "A.M. Schreiner" 3 => "M.K. Crow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semarthrit.2012.03.008" "Revista" => array:6 [ "tituloSerie" => "Semin Arthritis Rheum" "fecha" => "2012" "volumen" => "42" "paginaInicial" => "206" "paginaFinal" => "212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22572392" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interferon-β-induced pulmonary sarcoidosis in a 30-year-old woman treated for multiple sclerosis: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Petousi" 1 => "E.C. Thomas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1752-1947-8-344" "Revista" => array:5 [ "tituloSerie" => "J Med Case Rep" "fecha" => "2012" "volumen" => "8" "paginaInicial" => "344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25316102" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000006/v1_201505280222/S1579212915000993/v1_201505280222/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000006/v1_201505280222/S1579212915000993/v1_201505280222/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915000993?idApp=UINPBA00003Z" ]
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| 2021 August | 111 | 41 | 152 |
| 2021 July | 150 | 29 | 179 |
| 2021 June | 145 | 34 | 179 |
| 2021 May | 138 | 50 | 188 |
| 2021 April | 356 | 64 | 420 |
| 2021 March | 194 | 34 | 228 |
| 2021 February | 121 | 16 | 137 |
| 2021 January | 143 | 32 | 175 |
| 2020 December | 101 | 21 | 122 |
| 2020 November | 132 | 10 | 142 |
| 2020 October | 119 | 16 | 135 |
| 2020 September | 161 | 14 | 175 |
| 2020 August | 136 | 12 | 148 |
| 2020 July | 188 | 34 | 222 |
| 2020 June | 150 | 10 | 160 |
| 2020 May | 184 | 29 | 213 |
| 2020 April | 125 | 29 | 154 |
| 2020 March | 107 | 15 | 122 |
| 2020 February | 122 | 39 | 161 |
| 2020 January | 118 | 48 | 166 |
| 2019 December | 145 | 38 | 183 |
| 2019 November | 82 | 40 | 122 |
| 2019 October | 124 | 31 | 155 |
| 2019 September | 119 | 36 | 155 |
| 2019 August | 103 | 43 | 146 |
| 2019 July | 94 | 38 | 132 |
| 2019 June | 115 | 50 | 165 |
| 2019 May | 134 | 50 | 184 |
| 2019 April | 162 | 64 | 226 |
| 2019 March | 161 | 62 | 223 |
| 2019 February | 110 | 38 | 148 |
| 2019 January | 106 | 19 | 125 |
| 2018 December | 91 | 25 | 116 |
| 2018 November | 118 | 30 | 148 |
| 2018 October | 158 | 33 | 191 |
| 2018 September | 102 | 11 | 113 |
| 2018 May | 68 | 1 | 69 |
| 2018 April | 112 | 6 | 118 |
| 2018 March | 122 | 4 | 126 |
| 2018 February | 123 | 3 | 126 |
| 2018 January | 193 | 7 | 200 |
| 2017 December | 121 | 6 | 127 |
| 2017 November | 92 | 4 | 96 |
| 2017 October | 68 | 10 | 78 |
| 2017 September | 66 | 7 | 73 |
| 2017 August | 59 | 10 | 69 |
| 2017 July | 75 | 5 | 80 |
| 2017 June | 72 | 12 | 84 |
| 2017 May | 120 | 14 | 134 |
| 2017 April | 55 | 10 | 65 |
| 2017 March | 96 | 9 | 105 |
| 2017 February | 136 | 8 | 144 |
| 2017 January | 49 | 8 | 57 |
| 2016 December | 63 | 14 | 77 |
| 2016 November | 84 | 14 | 98 |
| 2016 October | 127 | 18 | 145 |
| 2016 September | 166 | 36 | 202 |
| 2016 August | 120 | 19 | 139 |
| 2016 July | 61 | 26 | 87 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 34 | 1 | 35 |
| 2015 September | 10 | 8 | 18 |
| 2015 August | 0 | 1 | 1 |
| 2015 July | 0 | 1 | 1 |
| 2015 June | 0 | 1 | 1 |
Show all
