Which pathophysiologic description best matches pulmonary sarcoidosis?

• A. Granulomas and inflammation of alveoli, small bronchi, and small blood vessels
• B. Inflammation and destruction of bronchial wall structural components
• C. Increased permeability of the alveolar-capillary membrane with diffuse alveolar damage
• D. Edema of the airways with eosinophils, neutrophils, and lymphocytes

Answer: (A)

Pulmonary sarcoidosis is driven by noncaseating granulomatous inflammation that often involves the lung interstitium, peribronchial regions, and small vessels. The choice that mentions granulomas with inflammation of the alveoli, small airways, and small blood vessels best fits this pattern, reflecting granulomatous involvement around airways and within the surrounding lung tissue rather than isolated alveolar edema or bronchial destruction. This distinguishes it from other processes: destruction of bronchial wall components points to bronchitis or bronchiectasis, diffuse alveolar damage with capillary leak is seen in ARDS, and edema with eosinophils, neutrophils, and lymphocytes suggests eosinophilic pneumonia or related inflammatory airway diseases.