【fmchdoctor】評論

(D)肺泡灌洗術(bronchoalveolar lavge)發現淋巴球數目及比例增高，CD4/CD8比例會下降 Evaluation•    Diagnosis is clinical and often one of exclusion•    Chest radiograph ◦                      bilateral hilar lymphadenopathy◦                      lungs involved in 90% of the cases•    Labs◦                      ↑ serum ACE (not uniformly) ◦                      hypercalcemia ▪                                        ↑ 1-α-hydroxylase → hypervitaminosis D▪                                                          can cause hypercalemia and renal failure chronically▪                                        commonly tested, less commonly seen (only about 11%)◦                      serum protein electrophoresis (SPE) shows polyclonal gammopathy◦                      lack of response to CD4 TH skin tests (like PPD) due to ↑ lung activity and ↓ systemic activity•    Pulmonary function tests◦                      restrictive pattern is common (normal FEV1/FVC with normal TLC)▪                                        however, obstructive or mixed pattern may also be seen•    Bronchoalveolar lavage◦                      high CD4:CD8 T-cell ratio ▪                                        due to CD4 infiltrate into the interstitium as well as intralveolar space▪                                        contrasted to the low ratio in hypersensitivity pneumonitis and HIV•    Biopsy ◦                      noncaseating granulomas with multinucleated giant cells   ▪                                        very suggestive of sarcoidosis ◦                      laminated calcium concretions present (cause of density on CXR)