Pulmonary sarcoidosis

Case contributed by Dr Heba Mohamed

Presentation

Long term history of chest troubles

Patient Data

Age: 70 years
Gender: Male
CT

   CT findings include multiple enlarged groups of calcified lymph nodes of the chest and upper abdomen. Right lower lobe calcified granuloma associated with multiple small subpleural cysts of honeycombing appearance, multiple areas of ground glass attenuation are noted as well. Bilateral irregular thickening of the pleura...CT findings may suggest possible pulmonary sarcoidosis.

 

Case Discussion

Sarcoidosis is a disorder characterized by noncaseating granulomas that may affect multiple systems. Involvement of the chest includes bilateral symmetrical enlarged hilar lymph nodes associated with interstitial lung disease.Pulmonary involvement includes micronodules, honeycombing, calcified granulomas as well as fibrotic changes, the involvement of the pleura may be seen as well.

1- an Atypical pattern of lymph node enlargement may be in abnormal distribution (eg, internal mammary, paravertebral, and retrocrural regions), in this case, other differentials as lymphoma or tuberculosis should be included.

2- Isolated enlarged hilar lymph node on one side may be encountered in less than 5% of cases.

3- Enlarged mediastinal lymph nodes without associated hilar lymph node enlargement is rarely encountered.

4- Calcification of the lymph nodes is a common sequel on the long run with calcification happens in 3% of patients after 5 years and in 20% after 10 years. The pattern of calcifications is variable may have an from amorphous to punctate, popcornlike, and eggshell-like appearance. 

Atypical patterns of lymphadenopathy occur more frequently in patients over than 50 years.

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Case information

rID: 52630
Case created: 14th Apr 2017
Last edited: 24th Apr 2017
System: Chest
Inclusion in quiz mode: Included

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