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Images in Thorax
Unilateral pleural effusion with pulmonary hypertension in sarcoidosis: do not forget the pulmonary veins!
  1. Elif Sumeyye Agaoglu1,
  2. Tom Semple2,
  3. Athol U Wells3,4,
  4. Stephen Wort1,4,
  5. Laura C Price1,4
  1. 1 National Pulmonary Hypertension Service, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
  2. 2 Radiology Department, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3 Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
  4. 4 Imperial College London National Heart and Lung Institute, London, UK
  1. Correspondence to Dr Elif Sumeyye Agaoglu, Guy's and St Thomas' NHS Foundation Trust, National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; elifsumeyye.agaoglu{at}nhs.net

https://doi.org/10.1136/thorax-2023-220058

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    A 64-year-old woman presented with exertional dyspnoea and ankle oedema. She had lung biopsy-confirmed sarcoidosis 6 years previously, having initially responded to prednisolone, with clinical stability for several years. Pulmonary function tests (PFTs) showed forced expiratory volume in 1 s, 2 litres; forced vital capacity, 2.5 litres; and carbon monoxide transfer factor, 4.03 (49.2% predicted). Chest radiography showed Scadding stage 4 sarcoidosis with prominent hila and coarse reticulation throughout both lungs. CT showed stable fibrotic features and ground-glass opacification, new right lower lobe interlobular septal thickening and right-sided pleural effusion (figure 1A). Echocardiography suggested severe pulmonary hypertension (PH) (estimated right ventricular (RV) systolic pressure 68 mm Hg) with RV dilatation, with confirmed precapillary haemodynamics on right heart catheterisation. Cardiac MRI revealed abnormal remodelling of the RV (without evidence of cardiac sarcoidosis); cardiac gated contrast CT angiography and ultimately …

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    Footnotes

    • X @pulmvasculardoc

    • Contributors ESA: writing the original draft, reviewing and editing. LCP: supervision and writing (review and editing). TS: resources and writing (review and editing). SW: writing (review and editing). AUW: writing (review and editing).

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.