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Typical and atypical manifestations of intrathoracic sarcoidosis.

Park HJ, Jung JI, Chung MH, Song SW, Kim HL, Baik JH, Han DH, Kim KJ, Lee KY - Korean J Radiol (2009 Nov-Dec)

Bottom Line: The findings include symmetric, bilateral hilar and paratracheal lymphadenopathy, with or without concomitant parenchymal abnormalities (multiple small nodules in a peribronchovascular distribution along with irregular thickening of the interstitium).However, in 25% to 30% of cases, the radiological findings are atypical and unfamiliar to most radiologists, which cause difficulty for making a correct diagnosis.We have collected cases with unusual radiological findings associated with pulmonary sarcoidosis (unilateral or asymmetric lymphadenopathy, necrosis or cavitation, large opacity, ground glass opacity, an airway abnormality and pleural involvement) and describe the typical forms of the disorder as well.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Kyunggi-do 442-723, Korea.

ABSTRACT
Sarcoidosis is a systemic disorder of unknown cause that is characterized by the presence of noncaseating granulomas. The radiological findings associated with sarcoidosis have been well described. The findings include symmetric, bilateral hilar and paratracheal lymphadenopathy, with or without concomitant parenchymal abnormalities (multiple small nodules in a peribronchovascular distribution along with irregular thickening of the interstitium). However, in 25% to 30% of cases, the radiological findings are atypical and unfamiliar to most radiologists, which cause difficulty for making a correct diagnosis. Many atypical forms of intrathoracic sarcoidosis have been described sporadically. We have collected cases with unusual radiological findings associated with pulmonary sarcoidosis (unilateral or asymmetric lymphadenopathy, necrosis or cavitation, large opacity, ground glass opacity, an airway abnormality and pleural involvement) and describe the typical forms of the disorder as well. The understanding of a wide range of the radiological manifestations of sarcoidosis will be very helpful for making a proper diagnosis.

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Related in: MedlinePlus

Imaging findings for mediastinal lymphadenopathy without hilar nodes are presented.A. Plain radiograph shows lymphadenopathy in right paratracheal region and para-aortic area (arrows). Both hilar shadows appear to be normal.B, C. Contrast enhanced CT scans show multiple enlarged nodes with homogeneous attenuation in mediastinum (arrows). However, both hilar zones are preserved.
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Figure 8: Imaging findings for mediastinal lymphadenopathy without hilar nodes are presented.A. Plain radiograph shows lymphadenopathy in right paratracheal region and para-aortic area (arrows). Both hilar shadows appear to be normal.B, C. Contrast enhanced CT scans show multiple enlarged nodes with homogeneous attenuation in mediastinum (arrows). However, both hilar zones are preserved.

Mentions: Hilar lymphadenopathy associated with sarcoidosis is typically bilateral and symmetric in distribution. This distribution pattern is an important diagnostic feature of sarcoidosis; a symmetric pattern is unusual for the other major diagnostic alternatives such as lymphoma, tuberculosis and metastatic disease (2-5). However, unilateral hilar lymphadenopathy is seen in less than 5% of cases, and is especially seen in patients older than 50 years of age. Unilateral hilar lymphadenopathy is approximately twice as common on the right side as compared to the left side and can occur either alone or with right paratracheal lymphadenopathy (Fig. 7). Mediastinal lymphadenopathy without hilar lymphadenopathy is even less common (Fig. 8). Moreover, isolated paratracheal or isolated subaortic lymphadenopathy has been rarely reported in sarcoidosis (4, 5, 8, 9) (Fig. 9).


Typical and atypical manifestations of intrathoracic sarcoidosis.

Park HJ, Jung JI, Chung MH, Song SW, Kim HL, Baik JH, Han DH, Kim KJ, Lee KY - Korean J Radiol (2009 Nov-Dec)

Imaging findings for mediastinal lymphadenopathy without hilar nodes are presented.A. Plain radiograph shows lymphadenopathy in right paratracheal region and para-aortic area (arrows). Both hilar shadows appear to be normal.B, C. Contrast enhanced CT scans show multiple enlarged nodes with homogeneous attenuation in mediastinum (arrows). However, both hilar zones are preserved.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2770817&req=5

Figure 8: Imaging findings for mediastinal lymphadenopathy without hilar nodes are presented.A. Plain radiograph shows lymphadenopathy in right paratracheal region and para-aortic area (arrows). Both hilar shadows appear to be normal.B, C. Contrast enhanced CT scans show multiple enlarged nodes with homogeneous attenuation in mediastinum (arrows). However, both hilar zones are preserved.
Mentions: Hilar lymphadenopathy associated with sarcoidosis is typically bilateral and symmetric in distribution. This distribution pattern is an important diagnostic feature of sarcoidosis; a symmetric pattern is unusual for the other major diagnostic alternatives such as lymphoma, tuberculosis and metastatic disease (2-5). However, unilateral hilar lymphadenopathy is seen in less than 5% of cases, and is especially seen in patients older than 50 years of age. Unilateral hilar lymphadenopathy is approximately twice as common on the right side as compared to the left side and can occur either alone or with right paratracheal lymphadenopathy (Fig. 7). Mediastinal lymphadenopathy without hilar lymphadenopathy is even less common (Fig. 8). Moreover, isolated paratracheal or isolated subaortic lymphadenopathy has been rarely reported in sarcoidosis (4, 5, 8, 9) (Fig. 9).

Bottom Line: The findings include symmetric, bilateral hilar and paratracheal lymphadenopathy, with or without concomitant parenchymal abnormalities (multiple small nodules in a peribronchovascular distribution along with irregular thickening of the interstitium).However, in 25% to 30% of cases, the radiological findings are atypical and unfamiliar to most radiologists, which cause difficulty for making a correct diagnosis.We have collected cases with unusual radiological findings associated with pulmonary sarcoidosis (unilateral or asymmetric lymphadenopathy, necrosis or cavitation, large opacity, ground glass opacity, an airway abnormality and pleural involvement) and describe the typical forms of the disorder as well.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Kyunggi-do 442-723, Korea.

ABSTRACT
Sarcoidosis is a systemic disorder of unknown cause that is characterized by the presence of noncaseating granulomas. The radiological findings associated with sarcoidosis have been well described. The findings include symmetric, bilateral hilar and paratracheal lymphadenopathy, with or without concomitant parenchymal abnormalities (multiple small nodules in a peribronchovascular distribution along with irregular thickening of the interstitium). However, in 25% to 30% of cases, the radiological findings are atypical and unfamiliar to most radiologists, which cause difficulty for making a correct diagnosis. Many atypical forms of intrathoracic sarcoidosis have been described sporadically. We have collected cases with unusual radiological findings associated with pulmonary sarcoidosis (unilateral or asymmetric lymphadenopathy, necrosis or cavitation, large opacity, ground glass opacity, an airway abnormality and pleural involvement) and describe the typical forms of the disorder as well. The understanding of a wide range of the radiological manifestations of sarcoidosis will be very helpful for making a proper diagnosis.

Show MeSH
Related in: MedlinePlus