Case 2
History:
35 year old female with shortness of breath
Findings:
There are bilateral, multiple tiny lung nodules along the bronchovascular bundle. Multiple mediastinum nodes are also seen along with splenic and hepatic nodules
Diagnosis:
Sarcoidosis
Discussion:
Enlarged nodes is the most common finding in sarcoidosis occurring in over 85% of cases. The typical pattern is paratracheal and bilateral hilar adenopathy (the so called “1,2,3 sign”). While not common, paratracheal, subcarinal, aortopulmonary window, and other mediastinal lymph node groups can be involved in the absence of hilar disease.
High resolution CT (HRCT) findings include areas of ground-glass appearance, subpleural and perivascular nodules, irregular thickening of bronchovascular bundles, and thickening of interlobular septa. Although nodular thickening of interlobular septa (so-called “beaded septa sign”) is more commonly described in lymphangitic spread of tumor, it can also be seen in sarcoidosis.
Clinical staging is based on the chest radiograph:
- Stage 0: Normal chest radiograph
- Stage I: Hilar and mediastinal lymph node enlargement
- Stage II: Lymphadenopathy and parenchymal disease
- Stage III: Parenchymal disease only
- Stage IV: Pulmonary fibrosis
References:
- Miller BH, Rosado-de-Christenson ML, et al. Thoracic sarcoidosis: radiologic-pathologic correlation. Radiographics 1995;15: 421-437.
