A 37-year-old woman presented with a 1-month history of daily cough and 30 lb unintentional weight loss. She was diagnosed with alveolar sarcoidosis based on radiographic findings of reticulonodular opacities. Alveolar sarcoidosis is a rare manifestation of pulmonary sarcoidosis characterized by interstitial granulomas compressing airways and mimicking airspace disease. The patient recovered with steroid treatment and follow-up imaging showed interstitial fibrotic changes, consistent with Stage 1 sarcoidosis.

1. Alveolar Sarcoidosis
Dr. Max Mam MD
Dr.Jayanth H.Jeshavamurthy MD

2. • A 37-year-old woman presents with one-month history of
daily cough and 30 lb. unintentional weight loss.

3. Which of the following
findings are present on
this radiograph?
• A: Air bronchograms
• B: Pneumothorax
• C: Cavitary lesions
• D: Reticulonodular opacities
• E: Multifocal airspace opacities

4. • A: Air bronchograms
• B: Pneumothorax
• C: Cavitary lesions
• D: Reticulonodular opacities
• E: Multifocal airspace opacities
Which of the following
findings are present on
this radiograph?

5. Which of the following
should be included in the
differential diagnosis?
• A: Lobar pneumonia
• B: Pulmonary tuberculosis
• C: Primary pulmonary lymphoma
• D: Cryptogenic organizing pneumonia
• E: Pulmonary sarcoidosis

6. Which of the following
should be included in the
differential diagnosis?
• A: Lobar pneumonia
• B: Pulmonary tuberculosis
• C: Primary pulmonary lymphoma
• D: Cryptogenic organizing pneumonia
• E: Pulmonary sarcoidosis

7. Which of the following is
the most likely diagnosis?
• A: Alveolar sarcoidosis
• B: Cryptogenic organizing
pneumonia
• C: Acute silicosis
• D: Usual interstitial pneumonia
• E: Chronic eosinophilic pneumonia

8. Which of the following is
the most likely diagnosis?
• A: Alveolar sarcoidosis
• B: Cryptogenic organizing
pneumonia
• C: Acute silicosis
• D: Usual interstitial pneumonia
• E: Chronic eosinophilic pneumonia

9. Patient recovered with
steroid treatment. Which of
the following findings are
present on follow-up CXR?
• A: Multifocal airspace consolidation
• B: Reticulonodular opacities
• C: Interstitial fibrotic changes
• D: Pleural plaques
• E: Interlobular septal thickening

10. Patient recovered with
steroid treatment. Which of
the following findings are
present on follow-up CXR?
• A: Multifocal airspace consolidation
• B: Reticulonodular opacities
• C: Interstitial fibrotic changes
• D: Pleural plaques
• E: Interlobular septal thickening

11. Based on the Siltzbach
classification system, which
stage of sarcoidosis does this
patient have?
• A: Stage 0
• B: Stage 1
• C: Stage 2
• D: Stage 3
• E: Stage 4

12. Based on the Siltzbach
classification system, which
stage of sarcoidosis does this
patient have?
• A: Stage 0
• B: Stage 1
• C: Stage 2
• D: Stage 3
• E: Stage 4

13. Alveolar sarcoidosis is a common manifestation of
sarcoidosis
• True / false?

14. Alveolar sarcoidosis is a common manifestation of
sarcoidosis
• True / false?

15. The pathophysiology of alveolar sarcoidosis involves
interstitial granulomas which enlarge and compress adjacent
airways, producing alveolar collapse and mimicking airspace
disease.
• True / false?

16. The pathophysiology of alveolar sarcoidosis involves
interstitial granulomas which enlarge and compress adjacent
airways, producing alveolar collapse and mimicking airspace
disease.
• True / false?

17. The CT “galaxy sign” describes confluent micronodular
granulomata which aggregate to form a mass-like
opacity.
• True / false?

18. The CT “galaxy sign” describes confluent micronodular
granulomata which aggregate to form a mass-like
opacity.
• True / false?

19. Alveolar sarcoidosis carries a favorable prognosis.
• True / false?

20. Alveolar sarcoidosis carries a favorable prognosis.
• True / false?

21. The Siltzbach classification system defines the five
stages of sarcoidosis on the basis of CT findings.
• True / false?

22. The Siltzbach classification system defines the five
stages of sarcoidosis on the basis of CT findings.
• True / false?

23. Summary
• Pulmonary involvement is common in sarcoidosis, which can present with
nonspecific symptoms including cough, dyspnea, chest pain, night sweats,
fatigue, and weight loss.
• Alveolar sarcoidosis is an uncommon manifestation of pulmonary
sarcoidosis and is characterized by interstitial granulomata which enlarge
and compress adjacent airways, producing alveolar collapse and mimicking
airspace disease.
• The CT “galaxy sign” is seen in alveolar sarcoidosis and describes a
confluence of numerous micronodular granulomas which aggregate to form
a mass-like opacity.
• Alveolar sarcoidosis carries a good prognosis with most patients achieving
remission even without treatment.

24. References
• Criado E, Sánchez M, Ramírez J, et al. Pulmonary sarcoidosis: typical
and atypical manifestations at high-resolution CT with pathologic
correlation. RadioGraphics. 2010;30:1567-1586.
• Ors, F., Gumus, S., Aydogan, M., Sari, S., Verim, S., & Deniz, O. (2013).
HRCT findings of pulmonary sarcoidosis; relation to pulmonary
function tests. Multidisciplinary Respiratory Medicine, 8(1), 8.
• Park, H. J., Jung, J. I., Chung, M. H., Song, S. W., Kim, H. L., Baik, J. H., …
Lee, K.-Y. (2009). Typical and Atypical Manifestations of Intrathoracic
Sarcoidosis. Korean Journal of Radiology, 10(6), 623–631.
• Traill ZC, Maskell GF, Gleeson FV. High-resolution CT findings of
pulmonary sarcoidosis. AJR Am J Roentgenol. 1997;168 (6): 1557-60.