Chest X-ray in Sarcoidosis: The Association of Age, Gender, and Ethnicity with Different Radiological Findings

Background: Sarcoidosis is a granulomatous disease that primarily affects the lung and lymphatic systems of the body. The Chest X-ray (Roentgenology) is the most common first imaging modality used in the diagnostic approach and follow-up of sarcoidosis, and is still used to determine the stage of sarcoidois based on the classification system proposed by Scadding (1961). Objective: We will assess the relation between different chest x-ray findings in sarcoidosis patients and both, demographic variables of sarcoidosis patients (age, gender, and race), along with different Scadding stages. Method: We included data regarding cases in the case-control ACCESS study, including demographic and clinical data, in addition to X-ray findings. From those with a biopsy-confirmed diagnosis of sarcoidosis in the ACCESS trial, we excluded patients with diseases that might contribute to X-ray abnormalities, including cardiac and respiratory non-sarcoidosis diseases (e.g. asthma and chronic bronchitis). We also excluded sarcoidosis patients without lung involvement. Results: A total of 499 patients were included in this study, of which 195 (39.1%) were men and 304 (60.9%) were women. We found that pleural abnormalities are most commonly associated with Scadding stage 2 (42.9%, p= 0.001), whereas Scadding stage 4 is associated with hilar retraction (52.8%, p< 0.001), bullae and bleps (73.7%, p< 0.001), and pulmonary artery enlargement (66.7%, p< 0.001). Finally, we also observed significant relations between demographic variables (age, gender, and race) and different imaging findings. Conclusion: Upon interpreting chest X-ray of sarcoidosis patients, patients' age, gender, and race should be kept in mind, as demographic variables are associated with chest X-ray findings in those patients. Moreover, each Scadding stage is associated with several findings on chest X-ray in sarcoidosis patients and should be interpreted accordingly.