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