jk amorosa. sarcoidosis, where does the name come from? sarc: flesh oid : like flesh-like ...
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JK Amorosa
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Sarcoidosis, where does the name come from?
Sarc: flesh Oid : like Flesh-like Besnier-Boeck-Schauman Disease
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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
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Sarcoidosis - pathology
Chronic inflammatory cells: monocytes, macrophages, activated T-lymphocytes form granulomas
Systemic inflammatory disease
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Lofgren Syndrome – good prognosis
Bilateral adenopathy
Erythema nodosum
Arthralgia
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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
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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
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What is Schauman body?
Calcium and protein inclusions in Langhans giant cell in a granuloma
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Asteroid body Granuloma
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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
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a.m. 3-19-12
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am 9-13-11
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Bilateral hilar and mediastinal adenopathy,Stage II, Ddx:
Lymphoma Small cell ca lung TB
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jf
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72 m
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Small cell ca with mediastinal adenopathy and pericardial mets
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Sarcoidosis
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Imaging Findings
Bilateral Peripheral, subpleural/peri-
bronchovascular, mid and lower lung zone
Basal patches of consolidation migratory
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Jf Adenopathy, fine nodular process, some along fissures
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35 f
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HRCT
Consolidation GG Nodules Reticular pattern Bronchial wall thickening and/or dilitation SPN Perilobular pattern Reverse halo Honeycomb
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27 yo f c SOB
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Ddx: mets, vasculitis, Sarcoidosis
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29 yo f c fever
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Sarcoid, septic infarcts
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CMV Pneumonia
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cocaine
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Chronic eosinophilic pneumonia
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Acute hypersensitivity Pneumonia
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Atoll
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Lung, stage IV Ddx:
Complicated silicosis Radiation fibrosis
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jd.
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66
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66 Calcified hilar nodes, atelectatic, bronchiectatic lung changes
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Dx: PMF, Conglomerate mass
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62 f fever
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Fungus ball, sarcoid
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31 f
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31 f
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31 f
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31 f
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31 f
Describe findings, procedures
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DDX:
Lymphoma BAC Chronic Eosinophilic Pneumonia Lung ca Aspiration Pneumonia Lipoid Pneumonia PE Sarcoid
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HRCT
Consolidation GG Nodules Reticular pattern Bronchial wall thickening and/or dilitation SPN Perilobular pattern Reverse halo Honeycomb
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DDX:
Lymphoma BAC Chronic Eosinophilic Pneumonia Lung ca Aspiration Pneumonia Lipoid Pneumonia PE Sarcoid
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BOOP= Polypoid plugs of loose granulation tissue within air spaces
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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