Sarcoidosis - perilymphatic nodular pattern

Case contributed by Charlie Chia-Tsong Hsu


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

Patient Data

Age: 60 years
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

See below

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

Annotated image

Arrows highlighting position of calcified mediastinal lymph nodes. 

Case Discussion

Sarcoidosis is a multisystem autoimmune disease characterized 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 characterized mediastinal adenopathy. Patient with progressive disease can develop pulmonary fibrosis as late sequelae. 

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