Sarcoidosis: perilymphatic nodular pattern

Case contributed by Dr Charlie Chia-Tsong Hsu

Presentation

Presents with cough, fatigue and lethargy. Initial chest radiograph showed hilar enlargement.

Patient Data

Age: 60
Gender: Male
Modality: CT

See below

Modality: CT

Calcified mediastinal lymph nodes in the paratracheal region (more pronounced on the right), hilar region, aortopulmonary window and subcarinal region. 

Modality: Annotated image

Arrows highlighting position of calcified mediastinal lymph nodes. 

Case Discussion

Sarcoidosis is a multisystem autoimmune disease characterised by non-caseating granulomas. Lung and lymphatic involvement is seen in 90% of patients. Majority of patient has stable disease or in remission with a minority of patient progressed to lung fibrosis. 

Chest radiograph appearance can be classified according to the Stiltzbach system 1:

  • stage 0: normal
  • stage 1: lymphadenopathy
  • stage 2: lung involvement
  • stage 3: both lung involvement and lymphadenopathy
  • stage 4: lung involvement only
  • stage 5: lung fibrosis.

Although widely known, this classification may not be a good indicator of disease severity. 

CT findings is variable but most commonly manifested by well defined nodules in the perilymphatic distribution. CT can also better characterised mediastinal adenopathy. Patient with progressive disease can develop pulmonary fibrosis as late sequlae. 

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Case Information

rID: 20881
Case created: 18th Dec 2012
Last edited: 19th Dec 2015
System: Chest
Inclusion in quiz mode: Included

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