Abstract
Granulomatous lung diseases are a heterogeneous group of disorders that have a wide spectrum of pathologies with variable clinical manifestations and outcomes. Precise clinical evaluation, laboratory testing, pulmonary function testing, radiological imaging including high-resolution computed tomography and often histopathological assessment contribute to make a confident diagnosis of granulomatous lung diseases. Differential diagnosis is challenging, and includes both infectious (mycobacteria and fungi) and noninfectious lung diseases (sarcoidosis, necrotising sarcoid granulomatosis, hypersensitivity pneumonitis, hot tub lung, berylliosis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, rheumatoid nodules, talc granulomatosis, Langerhans cell histiocytosis and bronchocentric granulomatosis). Bronchoalveolar lavage, endobronchial ultrasound-guided transbronchial needle aspiration, transbronchial cryobiopsy, positron emission tomography and genetic evaluation are potential candidates to improve the diagnostic accuracy for granulomatous lung diseases. As granuloma alone is a nonspecific histopathological finding, the multidisciplinary approach is important for a confident diagnosis.
Abstract
A multidisciplinary approach is crucial for the accurate differential diagnosis of granulomatous lung diseases http://ow.ly/FxsP30cebtf
Footnotes
Previous articles in this series: No. 1: Ghigna MR, Mooi WJ, Grünberg K. Pulmonary hypertensive vasculopathy in parenchymal lung diseases and/or hypoxia. Eur Respir Rev 2017; 26: 170003. No. 2: Bubendorf L, Lantuejoul S, de Langen AJ, et al. Nonsmall cell lung carcinoma: diagnostic difficulties in small biopsies and cytological specimens. Eur Respir Rev 2017; 26: 170007. No. 3: Rossi G, Cavazza A, Spagnolo P, et al. The role of macrophages in interstitial lung diseases. Eur Respir Rev 2017; 26: 170009.
Support statement: This study was supported by Arbeitsgemeinschaft zur Förderung der Pneumologie an der Ruhrlandklinik (AFPR) and Japan Society for the Promotion of Science (JSPS) KAKENHI Grant (number JP 16K09541). Funding information for this article has been deposited with the Crossref Funder Registry.
Conflict of interest: Disclosures can be found alongside this article at err.ersjournals.com
Provenance: Commissioned article, peer reviewed.
- Received January 26, 2017.
- Accepted May 25, 2017.
- Copyright ©ERS 2017.
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