Video-assisted thoracoscopic surgery (VATS) in sarcoidosis involving hilus and mediastinal lymphadenopathy

Abstract

Sarcoidosis is a multiorgan, granulomatous disease of unknown etiology. The diagnosis is determined based on clinical and radiographic findings of hilar and or mediastinal lymphadenopathy with or without focal lesions in the lung parenchyma. It is confirmed according to pathohistological findings of a non-caseous granuloma on biopsied lymph nodes or lung parenchyma obtained by standard bronchoscopy. VATS procedures are used when it is impossible to confirm the disease using standard diagnostic methods. Mainly, it is applied in the case of sudden worsening of conditions. The application of VATS is particularly justified because of a more straightforward approach to the target tissue of the mediastinum. This study aimed to determine the efficacy of the VATS procedure in diagnosing sarcoidosis-affected hilar and mediastinal lymph nodes. We presented a case of a 67-year-old patient with radiographic findings of hilar and mediastinal lymphadenopathy and focal lesions in the lung parenchyma. The patient unsuccessfully underwent multiple bronchological examinations. The pathohistological conclusion is not convincing for an accurate diagnosis of sarcoid lymphadenopathy. Due to disease progression and the appearance of bilateral pleural effusion with focal lesions on the lung parenchyma, the VATS procedure obtained lymph nodes, and lung parenchyma confirmed the diagnosis of sarcoidosis. Four months after the diagnosis and treatment with systemic corticosteroids, we observed significant radiological regression. In conclusion, VATS is an efficient and safe auxiliary diagnostic procedure in sarcoid hilar and mediastinal lymphadenopathy.