JK Amorosa

Sarcoidosis, where does the name come from?  Sarc: flesh  Oid : like  Flesh-like  Besnier-Boeck-Schauman Disease

Sarcoidosis–symptoms & findings Asymptomatic Fatigue Weight loss Aches-pains Arthritis Dry eyes SOB Erythema nodosum Enlarged lymph nodes Rashes Erythema nodosum Hepatomegaly Arrythmias Anemia Nerve palsy Parotid enlargement Abnormal Vitamin D regulation

Sarcoidosis - pathology  Chronic inflammatory cells: monocytes, macrophages, activated T-lymphocytes form granulomas  Systemic inflammatory disease

Lofgren Syndrome – good prognosis  Bilateral adenopathy  Erythema nodosum  Arthralgia

Imaging Summary Initial imaging for the diagnosis of sarcoidosis is Chest X- Ray.  HRCT can provide better resolution of lung findings  Radiographic Stages of disease progression  Stage 0: Normal CXR  Stage 1: bilateral hilar/mediastinal adenopathy  Stage 2: bilateral hilar /med adenopathy and pulmonary opacities  Stage 3: Diffuse pulmonary opacities alone  Stage 4: Diffuse pulmonary fibrosis

Paradoxical effect on inflammatory process – ANERGY ? related to increased risk of cancer and infections  HYPER Increase inflammation because of increased macrophages, CD4 helper T cell activation  HYPO Immune response to antigen challenges such as tuberculin is decreased

What is Schauman body?  Calcium and protein inclusions in Langhans giant cell in a granuloma

Asteroid body Granuloma

Imaging characteristics  Normal  Symmetrical smooth bilateral hilar and mediastinal adenopathy  Lung, early stages: perifissural, peribronchial nodules, miliary nodules, patchy focal opacities  Lung, late stages: distortion, atelectasis, cavities, bronchiectasis

a.m

am

Bilateral hilar and mediastinal adenopathy,Stage II, Ddx:  Lymphoma  Small cell ca lung  TB

jf

72 m

Small cell ca with mediastinal adenopathy and pericardial mets

Sarcoidosis

Imaging Findings  Bilateral  Peripheral, subpleural/peri- bronchovascular, mid and lower lung zone  Basal patches of consolidation  migratory

Jf Adenopathy, fine nodular process, some along fissures

35 f

HRCT  Consolidation  GG  Nodules  Reticular pattern  Bronchial wall thickening and/or dilitation  SPN  Perilobular pattern  Reverse halo  Honeycomb

27 yo f c SOB

Ddx: mets, vasculitis, Sarcoidosis

29 yo f c fever

Sarcoid, septic infarcts

CMV Pneumonia

cocaine

Chronic eosinophilic pneumonia

Acute hypersensitivity Pneumonia

Atoll

Lung, stage IV Ddx:  Complicated silicosis  Radiation fibrosis

jd.

66

66 Calcified hilar nodes, atelectatic, bronchiectatic lung changes

Dx: PMF, Conglomerate mass

62 f fever

Fungus ball, sarcoid

31 f

 Describe findings, procedures

DDX:  Lymphoma  BAC  Chronic Eosinophilic Pneumonia  Lung ca  Aspiration Pneumonia  Lipoid Pneumonia  PE  Sarcoid

HRCT  Consolidation  GG  Nodules  Reticular pattern  Bronchial wall thickening and/or dilitation  SPN  Perilobular pattern  Reverse halo  Honeycomb

DDX:  Lymphoma  BAC  Chronic Eosinophilic Pneumonia  Lung ca  Aspiration Pneumonia  Lipoid Pneumonia  PE  Sarcoid

BOOP= Polypoid plugs of loose granulation tissue within air spaces

References  H Prabhakar, C Rabinowitz, F Chew AJR. 2008;190: S1-S /AJR  G Boitsios et al AJ R 2010;194: W354-W /AJR