JK Amorosa
Sarcoidosis, where does the name come from?
Sarc: flesh Oid : like Flesh-like Besnier-Boeck-Schauman Disease
Sarcoidosis–symptoms & findings
• Asymptomatic• Fatigue• Weight loss• Aches-pains• Arthritis• Dry eyes• SOB• Erythema nodosum• Enlarged lymph
nodes
• Rashes• Erythema nodosum• Hepatomegaly• Arrythmias• Anemia• Nerve palsy• Parotid enlargement• Abnormal Vitamin D
regulation
Sarcoidosis - pathology
Chronic inflammatory cells: monocytes, macrophages, activated T-lymphocytes form granulomas
Systemic inflammatory disease
Lofgren Syndrome – good prognosis
Bilateral adenopathy
Erythema nodosum
Arthralgia
Imaging Summary
• Initial imaging for the diagnosis of sarcoidosis is Chest X-Ray.
HRCT can provide better resolution of lung findings
Radiographic Stages of disease progression Stage 0: Normal CXR Stage 1: bilateral hilar/mediastinal
adenopathy Stage 2: bilateral hilar /med adenopathy
and pulmonary opacities Stage 3: Diffuse pulmonary opacities alone Stage 4: Diffuse pulmonary fibrosis
Paradoxical effect on inflammatory process – ANERGY ? related to increased risk of cancer and infections
HYPER Increase inflammation because of increased macrophages, CD4 helper T cell activation
HYPO Immune response to antigen challenges such as tuberculin is decreased
What is Schauman body?
Calcium and protein inclusions in Langhans giant cell in a granuloma
Asteroid body Granuloma
Imaging characteristics
Normal Symmetrical smooth bilateral hilar
and mediastinal adenopathy Lung, early stages: perifissural,
peribronchial nodules, miliary nodules, patchy focal opacities
Lung, late stages: distortion, atelectasis, cavities, bronchiectasis
a.m. 3-19-12
am 9-13-11
Bilateral hilar and mediastinal adenopathy,Stage II, Ddx:
Lymphoma Small cell ca lung TB
jf
72 m
Small cell ca with mediastinal adenopathy and pericardial mets
Sarcoidosis
Imaging Findings
Bilateral Peripheral, subpleural/peri-
bronchovascular, mid and lower lung zone
Basal patches of consolidation migratory
Jf Adenopathy, fine nodular process, some along fissures
35 f
HRCT
Consolidation GG Nodules Reticular pattern Bronchial wall thickening and/or dilitation SPN Perilobular pattern Reverse halo Honeycomb
27 yo f c SOB
Ddx: mets, vasculitis, Sarcoidosis
29 yo f c fever
Sarcoid, septic infarcts
CMV Pneumonia
cocaine
Chronic eosinophilic pneumonia
Acute hypersensitivity Pneumonia
Atoll
Lung, stage IV Ddx:
Complicated silicosis Radiation fibrosis
jd.
66
66 Calcified hilar nodes, atelectatic, bronchiectatic lung changes
Dx: PMF, Conglomerate mass
62 f fever
Fungus ball, sarcoid
31 f
31 f
31 f
31 f
31 f
Describe findings, procedures
DDX:
Lymphoma BAC Chronic Eosinophilic Pneumonia Lung ca Aspiration Pneumonia Lipoid Pneumonia PE Sarcoid
HRCT
Consolidation GG Nodules Reticular pattern Bronchial wall thickening and/or dilitation SPN Perilobular pattern Reverse halo Honeycomb
DDX:
Lymphoma BAC Chronic Eosinophilic Pneumonia Lung ca Aspiration Pneumonia Lipoid Pneumonia PE Sarcoid
BOOP= Polypoid plugs of loose granulation tissue within air spaces
References
H Prabhakar, C Rabinowitz, F Chew AJR. 2008;190: S1-S6. 10.2214/AJR.07.7001
G Boitsios et al AJ R 2010;194: W354-W366. 10.2214/AJR.10.4345