대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 423 Date 2005-12-05

  • Courtesy of Kyung Hee Lee, MD / Inha University Hospital, Korea
  • Age/Sex 48 / M
  • Chief ComplaintAbnormal chest-PA on health check-up Cough and sputum for 10days
  • Figure 1
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  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Sarcoidosis
Radiologic Findings
Chest PA shows bilateral hilar prominency and diffuse ill-defined tiny nodules in both lungs. HRCT shows very small nodules and ground glass opacity in both lungs with upper lung dominancy. Fissural and subpleural nodules are seen. Mediastinal and bilateral hilar lymphadenopathy is visible using a soft tissue window. Transbronchial lung biopsy revealed multiple small non-necrotizing granulomas in bronchial wall and interstitium.
Brief Review
Sarcoidosis is a systemic disorder of unknown cause, characterized by the presence of noncaseating granulomas. Pulmonary manifestations are present in 90% of patients. Pulmonary lesions may resolve spontaneously or progress to fibrosis.



Lymph node enlargement : Mediastinal lymph node enlargement is very common with sarcoidosis, occurring in 60-90% of patients at some stage in their disease. CT shows abnormalities, in order of decresing frequency, in the right paratracheal space (100%), AP window (95%), hilar (90%), subcarinal space (65%), prevascular space (50%), and posterior mediastinum (15%). Node enlargement is usually appear bilateral and symmetrical on radiographys.



Lung diseases:

---Nodules : Pulmonary granulomas are found in relationship to lymphatics in the peribronchovascular interstitial space, subpleural interstitial space and , to a lesser extent, the interlobular septa. Nodules appear as small as a few millimeters in diameter. An upper lobe predominance of nodules is common but not invariable. Nodules may calcify. Large ill-defined opacities with or without air bronchograms, having the appearance of consolidation, can be seen. Large nodules (1 to 4cm) are seen in 15% to 25% of patients.

---Ground glass opacity usually reflects the presence of numerous very small granulomas.

---Reticular opacities and fibrosis.

---Bronchial and bronchiolar abnormalities



Pleural disease : About 1% of patients with sarcoidosis develop pleural abnormalities, pleural effusion or thickening.
References
Webb WR, Higgins CB Thoracic imaging Philadelphia : Lippincott Williams & Wilkins, 2005: 439-449
Keywords
Lung, Mediastinum, Connective tissue diseases, Sarcoidosis ,

No. of Applicants : 39

▶ Correct Answer : 27/39,  69.2%
  • - Gulf Diagnostic Center, United Arab of Emirates Amr Said
  • - Yonsei University Hospital, Korea Hyun Seok Choi
  • - Yonsei University Hospital, Korea Eun Hye Yoo
  • - Clinic 4, Moscow, Russia Lepikhina Dasha
  • - National Taiwan University Hospital, Taiwan Yu-Feng Wei
  • - Regional Imaging, Riverina, Australia Rashid Hashmi
  • - Jikei University School of Medicine, Tokyo, Japan Masuo Ujita
  • - Hereford County Hospital, UK Joy A Thomas
  • - Marien Hospital, Germany Davis Chiramel
  • - Maimonides Medical Center; Brooklyn, New York, USA Naomi Twersky
  • - Monaldi Hospital, Naples, Italy Gaetano Rea
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - National Taiwan University Hospital, Taiwan Kao-Lang Liu
  • - Busan National University Hospital, Korea Su-mi Shin
  • - Chosun University Hospital, Korea Jeongmin Lee
  • - Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
  • - Hanyang University Hospital, Seoul, Korea Yo Won Choi
  • - St. Vincent Hospital, Korea ChaeHun Lim
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Radiologie Guiton, La Rochelle, France Denis Chabassiere
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Annemasse, Polyclinique de Savoie, France Gay-Depassier
  • - Gwangmyoung Sungae Hospital, Korea Jiyong Rhee
  • - Apollo FirstMed Hospital, Chennai, India R G Gopinath
  • - ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi
  • - China Medical University Hospital,Taiwan Jun-Jun Yeh
  • - Ultracare, Coimbatore, India Debabrata Das
▶ Correct Answer as Differential Diagnosis : 9/39,  23.1%
  • - SSGH, Baroda Medical College, Vadodara, India Sushil Mansingani
  • - Samsung Medical Center, Seoul, Korea Ha Young Kim
  • - Yonsei University Hospital, Korea Yong Eun Chung
  • - Chikuhou Rousai Hospital, Japan Kouei Uchida
  • - Annecy Hospital, France Gilles Genin
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - Seoul National University Hospital, Korea Heesun Park
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