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Weekly Chest CasesArchive of Old Cases

Case No : 571 Date 2008-10-06

  • Courtesy of Yoon Kyung Kim, MD, Hwan-Seok Yong, MD, Eun-Young Kang, MD. / Korea University Guro Hospital, Korea
  • Age/Sex 45 / F
  • Chief ComplaintAbnormal finding on chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Sarcoidosis
Radiologic Findings
Chest radiographs show nodular bulging contour in left paratracheal area, AP window and left hilum. CT scan shows lymph node enlargement in mediastinum, both hilum, axilla, internal mammary area and retrocrural area in thorax. Lymphadenopathy is also noted in paracaval, paraaortic area, splenic hilum and mesentery in abdomen. Splenomegaly is also seen. Excisional biopsy of axillary lymph node revealed chronic noncaseous granulomatous inflammation compatible with sarcoidosis.
Brief Review
Sarcoidosis is a systemic disorder of unknown cause that is characterized by noncaseating granulomas with proliferation of epithelioid cells. Bilateral hilar lymphadenopathy is the most common radiologic finding. Adenopathy in the right paratracheal nodes, left aortic-pulmonary window, and subcarinal nodes can also be seen, often with associated pulmonary infiltrates.

However, extrathoracic involvement can be an initial manifestation in one-half of symptomatic patients. Although skin and ocular lesions are common, the liver, spleen, lymph nodes, parotid glands, central nervous system (CNS), genitourinary system, muscles, and bones may also be involved. Massive abdominal lymphadenopathy in the paraaortic region is rare but may be encountered in patients with systemic sarcoidosis. Imaging findings in these nodes are usually nonspecific, and differentiation from metastatic carcinoma or malignant lymphoma may be difficult. According to a report that compare lymph node involvement in sarcoidosis and lymphoma, retrocrural, paracaval/paraaortic, and pelvic lymph node enlargement are more frequently seen in lymphoma than sarcoidosis. Mean size of lymph nodes is larger in lymphoma than in sarcoidosis. Confluent mass formation is more common in lymphoma than sarcoidosis.
References
1. Britt AR, IR Francis, GM Glazer, and JH Ellis. Sarcoidosis: abdominal manifestations at CT. Radiology 1991 178: 91-94
2. Koyama T, Ueda T, Togashi K et al. Radiologic Manifestations of Sarcoidosis in Various Organs. RadioGraphics 2004; 24: 87-104.
Keywords
Mediastinum, Non-infectious inflammation, Sarcoidosis,

No. of Applicants : 87

▶ Correct Answer : 16/87,  18.4%
  • - Mackay Memorial Hospital , Taiwan Shen ShengYeh
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - BHMRC, NEW DELHI , India NIDHI GOYAL
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Gi Kim
  • - jiangsu province hospital , China yuan doctor
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Osaka University , Japan Osamu Honda
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - chp st martin , France Mariotte benoit
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - clinique de SAVOIE , France, Metropolitan gay depassier philippe
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
▶ Correct Answer as Differential Diagnosis : 30/87,  34.5%
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - McGill University Health Centre , Canada Amr Ajlan
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - Seoul National University Hospital , Korea (South) Hyun Ju Lee
  • - Seoul National University Hospital , Korea (South) Kwang Nam Jin
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - CHU Grenoble , France Fabrice Bing
  • - Regional Imaging Ltd. - Riverina, NSW, Australia , Australia Rashid Hashmi
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - NONE , India rekha gupta
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Soonchunhyang University Cheonan Hospital , Korea (South) Park Sang Hyun
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - kims,narkatpally , India k bhaskar
  • - McGill University Health Center , Canada Alexandre Semionov
  • - radiology department ANNECY , France gilles GENIN
  • - All India Institute of medical sciences , India Justin Moses
▶ Semi-Correct Answer : 40/87,  46.0%
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Samsung Medical Center , Korea (South) Eun Young Kim
  • - POPOVO HOSPITAL , Bulgaria Vladislav Rusinov
  • - Hanmaeum Hospital , Korea (South) Kwon Hyoung Kim
  • - INRAD - Faculty of Medicine, University of S Paulo , Brazil Natanael Ahn
  • - john h stroger hsp , United States dheeraj reddy gopireddy
  • - SNUH , Korea (South) Mi-Jin Kang
  • - K.J.SOMAIYA HOSPITAL AND RESEARCH CENTRE. , India vipul jethwa
  • - EKH-Berlin , Germany Michael Weber
  • - BOLLINENI HOSPITAL NELLORE , India jignesh dubal
  • - Stroger hospital , United States ky yoo
  • - dept of radiodiagnosis and imaging ,PGIMER , India srikala narayanan
  • - Arora Neuro Centre,Ludhiana , India DEVENDRA KUMAR
  • - jipmer , India ragu parasuraman
  • - OSWAL CANCER HOSP. , India VISHAL GARG
  • - Madras scan systems , India R.P Babu.
  • - Central Queensland Medical Imaging , Australia Sandeep Joshi
  • - chest hospital , Egypt assaad assaad
  • - MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
  • - University of Kocaeli , The faculty of Medicine , Turkey Salih Topcu
  • - UCLA , United States Fereidoun Abtin
  • - National Taiwan University Hospital , Taiwan Chin-Chung Shu
  • - Kwang Myung Sungae Hospital , Korea (South) Jiyong Rhee
  • - CHRU Lille , France Benjamin Damarey
  • - Yonsei University college of medicine Severance hospital , Korea (South) Hua Sun Kim
  • - Trakya University School of Medicine Department of Radiology , Turkey Devrim Urut
  • - Cheongshim international medical center , Korea (South) Hae Jum Yang
  • - EHIRC , India Aakash Mahajan
  • - SKN MEDICAL COLLEGE, Pune , India Anubhav Khandelwal
  • - Royal Oldham Hospital , United Kingdom Rajesh Annamalaisamy
  • - Clinic 1 , Russian Federation Lepikhina Darya
  • - ICL , France Regis Labroye
  • - Lilavati Hospital & Research Centre , India Mahavir Swami
  • - Apollo Gleneagles hosp , India salim parvez
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - NOUR EL-ISLAM RADIOLOGY CENTER , Egypt elsayed mousa
  • - ROHINI Scans (P) Ltd. , India UMAPATHI MAHESH
  • - Lilavati hospital and Research center , India vivek gupta
  • - KMC , India VIJAY BHARODIYA
  • - KMC,Manipal , India satish maddukuri
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