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Weekly Chest CasesArchive of Old Cases

Case No : 1017 Date 2017-04-24

  • Courtesy of Cherry Kim, Eun Jin Chae, Kyung-Hyun Do, Jae Woo Song / Asan Medical Center
  • Age/Sex 75 / M
  • Chief Complaintdyspnea for 1 month, underlying diabetes
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pulmonary tuberculosis showing the galaxy sign
Radiologic Findings
Fig 1. Chest radiograph shows disseminated tiny nodules and multifocal patchy confluent opacities without zonal predominance in both lungs.
Figs 2-5. Axial and coronal chest computed tomography images with lung window setting show multiple disseminated irregular centrilobular nodules and irregular patchy consolidations composed of coalescent tiny irregular nodules in both lungs, sparing the subpleural areas.
Brief Review
The galaxy sign represents a mass-like lesion, composed of innumerable coalescent granulomatous nodules, more concentrated in the center than at the periphery. It was initially described in patients with sarcoidosis and was referred to as the 'sarcoid galaxy' sign. It is now known to be present in other entities such as tuberculosis, lung cancer, and progressive massive fibrosis in pneumoconiosis.
Although tuberculous and sarcoid clusters of small nodules themselves appear indistinguishable on CT, some features might be helpful for differentiating them. First, a single cluster of small nodules is far more common in patients with tuberculosis than in those with sarcoidosis. Second, sarcoid clusters of small nodules are usually seen in the upper and middle lobes with almost the same frequency and are rare in the lower lobes, whereas most tuberculous clusters are in the upper lobes and the superior segments of the lower lobes in the same frequency, reflecting the typical distribution of post-primary pulmonary tuberculosis. Thus, clusters of small nodules in the middle lobe favor the diagnosis of sarcoidosis, and those in the lower lobe favor the diagnosis of tuberculosis. Finally, lymphadenopathy is common in patients with sarcoid clusters but is rare in patients with tuberculous clusters. Tree-in-bud lesions, one of the characteristic features of tuberculosis, should suggest the diagnosis of tuberculosis.
References
1. Nakatsu M, Hatabu H, Morikawa K, et al. Large coalescent parenchymal nodules in pulmonary sarcoidosis:“sarcoid galaxy” sign. AJR 2002;178:1389–1393.
2. Heo JN, Choi YW, Jeon SC, et al. Pulmonary Tuberculosis: Another Disease Showing Clusters of Small Nodules. AJR 2005;184:639–642.
Keywords
Lung, Pulmonary tuberculosis, Galaxy sign,

No. of Applicants : 107

▶ Correct Answer : 33/107,  30.8%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Private Practice , Greece AGISILAOS DERVAS
  • - the First Affiliated Hospital of NanJing Medical University , China AIPING CHEN
  • - Other , Korea (South) SEONG SU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - , China JIE YU
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - The Jikei university , Japan TAKU GOMI
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Asan Medical Center , Korea (South) JIHYE KWON
  • - Okayama Red Cross Hospital , Japan KAZUAKI MUNETOMO
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Chonbuk National University Hospital , Korea (South) IM WON HYEONG
  • - , Brazil MARCEL KOENIGKAM SANTOS
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - , Korea (South) JEONGBIN PARK
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Seoul National University Hospital , Korea (South) Yongsub Song
  • - Pusan National University Yangsan Hospital , Korea (South) JUNMEE YOU
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
▶ Correct Answer as Differential Diagnosis : 30/107,  28.0%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - McGill University Health Center , Canada Alexandre Semionov
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - , India RAMESH DHARAVATH
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - Busan National University Hospital , Korea (South) LEE YOU JIN
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Other , Korea (South) JIYEON HAN
  • - Seoul National University Hospital , Korea (South) JI EUN KIM
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Chungbuk national university , Korea (South) Yong Hun Kim
  • - Other , Korea (South) HAYEON LEE
  • - Kyeongpook National University Hospital , Korea (South) SUNGJUN MOON
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - , India TEKWANI PARMANAND HOLARAM
  • - Chonbuk National University Hospital , Korea (South) WEON JANG
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Samsung Medical Center , Korea (South) NARI SHIN
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Ibaraki-gazou-shindan , Japan SHOICHI KATOH
  • - Samsung Medical Center , Korea (South) Jeonghyun Lee
  • - The University of Tokyo Hospital , Japan TAKUMIDA HIROSHI
  • - Private sector , Greece VASILIOS TZILAS
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Current Editor : Sang Young Oh, M.D., Ph.D Email : sangyoung.oh@gmail.com

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