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J Thorac Cardiovasc Surg 2002;124:171-175
© 2002 The American Association for Thoracic Surgery

Clinical-Pathologic Conference (CPC)

Clinical-pathologic conference in general thoracic surgery: Bilateral lung transplantation for sarcoidosis with aspergilloma

From the Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.

Received for publication Oct 12, 2001. Accepted for publication Oct 31, 2001. Address for reprints: G. Alexander Patterson, MD, Washington University School of Medicine, Department of Cardiothoracic Surgery, One Barnes Hospital Plaza, Suite 3108 Queeny Tower, St Louis, MO 63110 (E-mail: pattersona@msnotes.wustl.edu).

The first 300 words of the full text of this article appear below.

	Introduction

 
This case is available for further study on the World Wide Web at: http://ctsnet.org/doc/3196.

Participants

From the Washington University
School of Medicine, Barnes-Jewish
Hospital, St Louis, Missouri

Thoracic Surgery
Dr G. Alexander Patterson
Dr Anna Maria Ciccone

Radiology
Dr Harvey Glazer

Pulmonary Medicine
Dr Elbert Trulock

Surgical Pathology
Dr Jon Ritter

	Case presentation

 
Dr Ciccone: The patient is a 47-year-old man who was hospitalized 16 years ago for "asthma." He had a less than complete response to initial therapy, and his treating physician's inclination at that time was that he had tuberculosis. That same year, a diagnosis of sarcoidosis was established after a lung biopsy. He had a history of systemic hypertension, osteoporosis, and gout. His condition remained stable until 3 years ago, at which time his symptoms of dyspnea worsened. He required increasing supplemental oxygen. Two years ago he was seen, evaluated, and eventually listed for bilateral lung transplantation. By spirometry, the forced expiratory volume in 1 second was only 0.55 L, 16% of predicted, and the forced vital capacity was 1.81 L, or 44% of predicted.

Six months ago he was hospitalized for an exacerbation of his respiratory symptoms. He was treated and enrolled in our pulmonary rehabilitation program.

On physical examination, the patient had poor chest excursion and coarse breath sounds bilaterally. The remainder of his physical examination was unremarkable.

Perhaps we could review the relevant radiographic findings.

Dr Glazer: Chest radiograph and computed tomographic images demonstrate findings consistent with the clinical diagnosis of end-stage sarcoidosis. The chest radiograph (Figure 1) shows extensive bullous formation and scarring, predominantly in the mid and upper lungs, with compensatory hyperinflation in the lower lungs. Superior retraction of the hila is seen. An opacity is seen within the dependent portion of a large cystic space in the left upper hemithorax, likely representing . . . [Full Text of this Article]