Purpose
Sarcoidosis is a non-rare,
probabily multifactorial,
systemic granulomatous disease with variable course and prognosis.
Pulmonary involvement is substantial universal in patient affected by sarcoidosis,
and it can occur with a variety of pattern.
Typical pattern consist in the presence of small nodules with perilymphatic distribution,
with symmetric caudo-cranial gradient of distribution and symmetrical non calcified lymphadenopathy; finding of ground-glass opacity (GGO),
mass-like opacity,
halo-sign,
airway involvement,
honey-combing and thickening of the intralobular septa instead constitute an atypical presentation [1].
The aim of this study is...
Methods & Materials
From the electronic database of a regional Centre for interstitial and rare lung disease,
we selected patients with a diagnosis of pulmonary sarcoidosis.
Our analysis included patients with clinical diagnosis confirmed by bronchoalveolar lavage and/or biopsy,
according to the ATS/ERS/WASOG criteria [2],
during the period 2013-2018.
Their HRCT examinations were retrospectively reviewed by two radiologists with proven experience in pulmonary diseases: typical (perilymphatic and peribroncovascular distribution,
mediastinal enlarged nodes,
etc.) and atypical (consolidations,
ground-glass opacities,
atypical nodules and masses,
airway involvement,
atypical lymphadenopathy) appearances were...
Results
A total of 100 patients (42 males,
58 females,
average age 56,82±16,17) with a diagnosis of sarcoidosis were analyzed; 59 patients showed a typical pattern,
whereas 41 patients had atypical findings on imaging.
In the latter subgroup we found the following HRCT features: ground-glass opacity (29,26%),
atypical nodules and masses (26,82%),
atypical lymphadenopathy (24,39%),
non-typical interstitial fibrotic alterations (16,63%),
thickening of the intralobular septa (7,31%),
airway involvement (7,31%),
and pleural involvement (2,4%); we also found a case with Reverse Halo-Sign.
Typical and atypical features may...
Conclusion
Atypical parenchymal patterns can create confusion both to the clinician and the radiologist as they mimic different diffuse diseases of the lung parenchyma,
just as it is difficult to attribute a correct meaning to the atypical lymphadenopathy.
Atypical appearance of sarcoidosis may be encountered with relative frequency on HRCT imaging,
and radiologists should be aware of these morphological appearances,
in order to reduce interpretative errors.
References
1.
SpagnoloP,
Sverzellati N,
Wells AU,
Hansell DM.
Imaging aspects of the diagnosis of sarcoidosis.
Eur Radiol.
2014 Apr;24(4):807-16.
doi: 10.1007/s00330-013-3088-3.
Epub 2014 Jan 8.
Review.
PubMed PMID: 24399491.
2.
Statement on sarcoidosis.
Joint Statement of the American Thoracic Society (ATS),
the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee.
(1999) Am J Respir Crit Care Med 160:736-755.
3.
Polverosi R,
Russo R,
Coran A,...
Personal Information
Giulio Distefano,
Radiology resident
Radiology Unit 1,
Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia” – Radiology I Unit,
University Hospital “Policlinico-Vittorio Emanuele”,
University of Catania,
Catania,
Italy