Localization to the lungs is by far the most common manifestation of sarcoidosis.[16] At least 90% of affected persons experience lung involvement.[2] Overall, about 50% develop permanent pulmonary abnormalities, and 5 to 15% have progressive fibrosis of the lung parenchyma. Sarcoidosis of the lung is primarily an interstitial lung disease in which the inflammatory process involves the alveoli, small bronchi and small blood vessels.[17] In acute and subacute cases, physical examination usually reveals dry rales.[2] At least 5% of persons will suffer pulmonary arterial hypertension.[2][18] Less commonly, the upper respiratory tract (including the larynx, pharynx, and sinuses) may be affected, which occurs in between 5 and 10% of cases.[19]
Sarcoidosis of the lungs can be divided into four stages. Stage 0 — No intrathoracic involvement. Stage I — Bilateral hilar adenopathy. Stage II — Pulmonary parenchyma involved. Stage III — Pulmonary infiltrates with fibrosis.[2] Stage 4 is end-stage lung disease with pulmonary fibrosis and honeycombing.[20]
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