대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Sarcoidosis

Radiologic Findings

Initial chest radiography shows heterogeneous increased opacities in both lungs. Multiple cystic lesions are noted on the left lung. Axial CT scans obtained a day after chest radiography show diffuse ground glass opacities predominantly in the right upper lung area. Diffuse fine nodules are noted along the bronchovascular bundle and pleura. Multiple cystic lesions are noted in the left lung along with atelectasis of the left lower lobe.

Lung lesions were highly suggestive of sarcoidosis. However, multiple lung cysts in the left side are unsual for sarcoidosis because those caused by sarcoidosis usually abut areas of fibrotic masses and these cysts probably represent paracicatricial emphysema (AJR 2000;174:1751?757). So the cystic lung lesions were considered incidental and unassociated with the right lung lesions. Biopsy of small supraclavicular lymph nodes was formed under the impression of sarcoidosis and showed noncaseating granulomas characteristic of sarcoidosis. Further studies revealed elevated angiotensin converting enzyme and negative results for PPD skin test, supporting the diagnosis of sarcoidosis.

Administration of steroid medication was followed by immediate improvement of symptoms and radiographic features. However, chest radiography obtained 3 months later showed persistent cystic lesions in the left lung.

Brief Review

References

Please refer to

Case 129

Keywords

Lung, Connective tissue diseases, Sarcoidosis ,