“SARCOIDOSIS”

Sarcoidosis is a multi-system granulomatous disease that is more common in women and those of African descent. Typically presents at less than 40 years of age. Up to 50% are asymptomatic; otherwise, symptoms are non-specific—cough, chest pain, weight loss, etc. The lungs are affected in 90% and pulmonary complications account for most morbidity and mortality.
PLAIN FILM
•  Bilateral hilar lymph node enlargement plus right paratracheal lymph node enlargement (‘Garland triad’)—this is classic.
•  Also check for airspace infiltration, nodules and fibrosis (upper zones).
HRCT 
•  Upper/mid zone tiny nodules 2-4 mm or larger and coalescing in a perilymphatic distribution (i.e. along sub-pleural surfaces, fissures and peribronchovascular bundles).
•  Nodular, interlobular septal thickening.
•  Fibrosis with traction bronchiectasis.
•  Note: The above are the abnormalities most commonly associated with pulmonary sarcoidosis. There are a myriad of alternative abnormalities—sarcoid is a great mimicker!
 Typical sarcoidosis. High-resolution computed tomography image of sarcoidosis, demonstrating small nodules in a perilymphatic distribution (i.e. along the fissure; fissural beading) (white arrow) and along bronchovascular bundles (red arrow).



 

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