Garland triad

Last revised by Mostafa El-Feky on 18 Jan 2023

Garland triad, also known as the 1-2-3 sign or pawnbroker's sign, is a lymph node enlargement pattern on chest radiographs which has been described in sarcoidosis:

  1. right paratracheal nodes

  2. right hilar nodes

  3. left hilar nodes

Hilar lymphadenopathy is symmetrical and usually massive. These so-called potato nodes typically do not abut the cardiac border which distinguishes the nodal enlargement from lymphoma 2.

Involvement of right paratracheal nodes reflects the ease with which these nodes are identified on plain radiography.

Left paratracheal and aortopulmonary nodes are frequently enlarged but harder to identify 1.

History and etymology

L (Leo) Henry Garland (1903-1966) 4 was an Irish-born American radiologist who published his experience of the radiographic appearances of 36 cases of sarcoidosis in a paper published in 1947 3. The combination of bilateral hilar and right paratracheal adenopathy was found in 13 cases, 7 with lung changes and 6 without, although in early disease was present in about two-thirds of cases. Of course, like most eponyms:

  • he was not the first to describe it (see Stigler's law)

  • he did not name it after himself

  • and, in addition, did not use the word triad in his paper 3

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Cases and figures

  • Figure 1: pawnbroker symbol
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  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5
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