JK Amorosa
SARCOIDOSIS FLOP
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
 Complicated silicosis
 Radiation fibrosis
Ddx:
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