The Garland triad, also known as the 1-2-3 sign or pawnbroker's sign, is a chest radiograph pattern commonly seen in sarcoidosis comprising symmetrical hilar and right paratracheal lymphadenopathy.
In Garland’s series, this was the most frequent radiographic pattern. With the advent of CT, bilateral hilar and mediastinal lymphadenopathy is the rule, however left mediastinal lymphadenopathy is sometimes occult on chest radiography, obscured by the great vessels 1.
Hilar lymphadenopathy in sarcoidosis is usually obvious, sometimes massive. These so-called potato nodes are typically separated from the cardiac border, a feature that helps to differentiate sarcoidosis from lymphoma 2.
History and etymology
Henry Garland (1903-1966) 4 was an Irish-born American radiologist who presented his experience of 36 established cases of sarcoidosis at the 32nd annual meeting of the RSNA in 1946 3. The combination of bilateral hilar and right paratracheal adenopathy was found in 13 of the 24 cases with lymphadenopathy on CXR, 7 with radiographic lung disease and 6 without. He noted that this CXR pattern may have diagnostic value but the term ‘Garland triad’ was applied by a subsequent author.
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