Sarcoidosis - ground glass opacity and perilymphatic nodular pattern

Case contributed by Charlie Chia-Tsong Hsu


30 year old male. Acute shortness of breath and cough.

Patient Data

Age: 30
Gender: Male

Respiratory motion artifact limits image quality.

Predominate patterns are of patchy ground glass opacities and numerable perilymphatic nodules.

Numerable perilymphatic nodules are best appreciated on magnified views (red arrows). In some regions the nodules coalesce to from conglomerate masses (yellow arrow). 

Peribronchovascular thickening (blue arrow) and irregular fissural thickening (green arrow). 

Follow-up chest x-ray after commencement of treatment. 

Case Discussion

The predominate pattern described include patchy ground glass opacity with superimposed perilypmhatic nodules which form coalesce to from mass in some regions. 

Microscopic description: Transbronchial biopsy and washing from the anterior segment of the right upper lobe showed numerous non-necrotizing, sharply circumscribed granulomas with paucity of inflammatory cells. The granuloma is also seen within the alveolar interstitium. The intervening alveolar space is normal with no evidence of fibrosis. 

The imaging and histology findings are consistent with the diagnosis of sarcoidosis. The case demonstrate an example of ground glass pattern of sarcoidosis on CT. Microscopically this is due to extensive granuloma infiltration of the pulmonary interstitium rather than an alveolar disease process. 

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