Sarcoidosis
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Sarcoidosis

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Sarcoidosis Sarcoidosis Presentation Transcript

  • Dr/ Hytham Nafady Bernie Mac
  • Definition • Multisystem chronic inflammation characterized by non caseating granulomas. Caseating granulomas TB Non caseating granulomas Sarcoidosis
  • Sarcoidosis • Can involve any organ. • 90% thoracic (lung & LN). • Thoracic involvement accounts for most of the morbidity & mortality associated with the disease.
  • Epidemiology • Age: 3rd decade. • Sex: F > M. • Race: black Americans.
  • Erythema nodosum
  • Laboratory findings • Kviem test +ve. • Elevated angiotensin converting enzyme (ACE)
  • Lofgren syndrome • Acute sarcoidosis characterized by triad
  • Heerfordt’s syndrome • Acute sarcoidosis characterized by uveoparotitis
  • Heerfordt’s syndrome
  • Pulmonary sarcoidosis
  • Pulmonary sarcoidosis
  • Paradoxical response • One of the distinguishing features of sarcoidosis. • As the lung disease worsens, • the nodal enlargement usually regresses.
  • Calcified hilar & mediastinal LN
  • Calcified hilar & mediastinal LN Calcified hilar LN
  • Calcified hilar & mediastinal LN
  • Calcified hilar & mediastinal LN
  • Hilar enlargement Unilateral hilar enlargement Bilateral hilar enlargement •Sarcoiosis •Silicosis Infection •TB •TB Neoplasm •Bronchogenic carcinoma. •Metastasis (lung, head & neck, thyroid or testis). •Lymphoma •Metastases Vascular •Post-stenotic dilatation (left side). •Pulmonary artery aneurysm. •Pulmonary hypertension. •Pulmonary artery aneurysm.
  • LN enlargement # pulmonary vascular enlargement Smooth Lobulated
  • DD of calcified hilar or mediastinal LN • • • • Silicosis Sarcoidosis. TB. Treated lymphoma.
  • Parenchymal sarcoidosis
  • Typical parenchymal sarcoidosis Interstitial micronodules • Coalescent groups of microscopic granulomas. • Well defined, with irregular margins. • 2-4 mm. Location: • Bilateral upper lobe predominance. • Bilateral perihilar. Distribution:(Perilymphatic distribution) • Peribronchovascular interstitium, • Interlobular septa & • Subpleural (subpleural plaques & fissure nodules).
  • Upper lobe predominance
  • Bilateral perihiar predominance
  • Nodular thickening of the peri-broncho-vascular interstitium
  • Nodular thickening of interlobular septa nodular fissures Nodular thickening of interlobular septa: Irregular or nodular. Nodular fissures: Dot-dash pattern (.-.-.-.-.-.-).
  • Sub-pleural nodules (pseudo-plaques)
  • Fissure nodules
  • DD of nodular interstitial thickening • Sarcoidosis. • Lymphangitis carcinomatosis.
  • Typical parenchymal sarcoidosis Fibrosis • Reticular opacities. • Traction bronchiectasis. • Architectural distortion.
  • Atypical parenchymal sarcoidosis Pulmonary nodules or masses 15-25 %
  • Sarcoid Galaxy sign
  • Atypical sarcoidosis Pulmonary consolidation 10-20%
  • Atypical parenchymal sarcoidosis Patchy ground glass opacities 40%
  • Atypical parenchymal sarcoidosis Linear reticular opacities 15-20%
  • Atypical parenchymal sarcoidosis Miliary opacities Rare 1%
  • Pleural disease Rare < 1% • Pleural effusion. • Hemothorax. • Chylothorax (due to involvement of the mediastinal LN or thoracic duct).
  • Air way involvement • May occur at any level • Bronchial wall thickening • Luminal abnormalities • Obstruction of lobular or segmental bronchi • Mosaic perfusion • Air-trapping on expiration
  • Atlas of sarcoidosis
  • Case 1
  • Case 2
  • Case 3
  • Case 4
  • Case 5
  • Case 6
  • Case 7
  • Case 8
  • Neurosarcoidosis
  • Neurosarcoidosis Parenchymal Pachymeningeal Leptomeningeal
  • Periventricular white matter non enhancing lesions
  • Multiple enhancing nodules
  • Nodules may have low T2 signal due to high cellularity
  • Pachymeningeal sarcoidosis • Dural mass. • Diffuse dural thickening.
  • Pachymeningeal sarcoidosis dural masses
  • Pachymeningeal sarcoidosis diffuse dural thickening
  • Breast cancer metastasis Intracranial hypotension VPS SDH
  • Leptomeningeal sarcoidosis • • • • Basal cisterns. Cerebral sulci. Cerebellar fissures. Virchow Robin perivascular spaces.
  • Leptomeningeal sarcoidosis basal cisterns
  • Leptomeningeal sarcoidosis Perivascular spaces Corticosteroids
  • Leptomeningeal sarcoidosis cerebellar fissures
  • Leptomeningeal or pachymeningeal? Lymphoma Sarcoidosis
  • Mixed leptomeningeal & pachymeningeal thickening Lymphoma Sarcoidosis
  • Cranial nerve involvement • Optic nerve. • Facial nerve.
  • Optic N sarcoidosis
  • DD of bilateral optic neuritis • MS. • Devic’s disease • Sarcoidosis.
  • Hypothalamic sarcoidosis
  • Pituitary stalk sarcoidosis
  • Calvarial sarcoidosis
  • Calvarial sarcoidosis
  • Pacchionian granulation
  • Parietal foramina
  • Leptomeningeal cyst
  • Calvarial hemangioma
  • Eosinophilic granuloma
  • Calvarial metastasis
  • Musculoskeletal sarcoidosis
  • Musclar nodular sarcoidosis • Low signal intensity centre due to fibrosis.
  • Sarcoid dacytilits • Tenosynovitis + lace like lytic lesion
  • DD of dactylitis • • • • • TB (spina ventosa). Syphilis (TB like but bilateral & symmetrical). Sarcoid dactylitis (lace like lytic pattern). Psoriasis (sausage digit). Sickle cell dactylitis (hand & foot syndrome).
  • Orbital sarcoidosis • Bilateral enlargement & enhancement of the lacrimal glands. • Bilateral uveitis.
  • DD of bilateral lacrimal gland enlargement • • • • • • Sjogren syndrome. Miculik’s disease. Sarcoidosis. TB. Orbital pseudotumor Lymphoma.
  • Bilateral parotitis
  • Panda sign • Bilateral lacirmal gland, parotid gland & normal nasopharyngelal uptake, on Ga-67 scintigraphy.