sarcoid - chest...radiographic staging • stage 0: normal chest radiograph • 5-10% of patients at...

Radiology Presentation Ashton Lai

MS4 2/21/2018

H&P

• MR965617

• 56y/oF w/ HTN, DM2, OSA p/w dry cough x 2 wks, palpitationsand right lower leg pain

Right Lower Leg

4/2015 right leg: MICROSCOPIC DESCRIPTION: The specimen consists of epidermis and dermis. Sections show a dermal inflammatory infiltrate including relatively scant lymphocytes and epithelioid histiocytes arranged in well-defined granulomas. Giant cells are seen. There are not prominent epidermal changes. Polarization is negative. There is slight hyperorthokeratosis with a slightly diminished granular cell layer.

Clinical Features

• Pulmonary, Cardiac, Musculoskeletal (arthralgias, etc), CNS (palsies, endocrine, etc) • Lofgren’s syndrome:

1) EN 2) hilar adenopathy 3) Arthritis

Radiographic Features

• Galaxy Sign • Garland’s Triad (1-2-3 sign):

1) Right paratracheal nodes 2) Right hilar nodes 3) Left hilar nodes

• Panda’s Sign

Radiographic Staging

• stage 0: normal chest radiograph • 5-10% of patients at presentation

• stage I: hilar or mediastinal nodal enlargement only • 45-65% of patients at presentation

• stage II: nodal enlargement and parenchymal disease • 25-30% of patients at presentation

• stage III: parenchymal disease only • 15% of patients at presentation

• stage IV: end-stage lung (pulmonary fibrosis)

H&P

• MR965617

• 56y/oF w/ HTN, DM2, OSA p/wdry cough x 2 wks, palpitations and right lower leg pain

• Failed on just prednisone • Now on methotrexate and prednisone

• w/u for cardiac sarcoid (MRInegative) and f/u w/ optho

Cardiac MRI • Increased signal intensity on T2-weighted MRI 2/2 edema (a) • Delayed enhancement reflecting accumulation of Gd chelates intissue • Focal myocardial thickening

References

• https://radiopaedia.org/articles/pulmonary-sarcoidosis-staging-on-chest-radiograph • https://emedicine.medscape.com/article/361490-overview • American Journal of Roentgenology. 2005;184: 249-254.10.2214/ajr.184.1.01840249 https://www.ajronline.org/doi/full/10.2214/ajr.184.1.01840249