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Weekly Chest CasesArchive of Old Cases

Case No : 98 Date 1999-09-11

  • Courtesy of Kyung Joo Park, MD / Ajou University Medical Center, Suwon, Korea
  • Age/Sex 32 / M
  • Chief ComplaintWeight loss , fatigue, and poor oral intake for two months
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Sarcoidosis
Radiologic Findings
Chest radiograph shows poorly-defined, patchy opacities in the bilateral lungs, involving mainly mid and lower zones with hilar enlargement and right paratracheal mediastinal widening.

Kerley's lines are seen in the lower lung zones with right pleural effusion.

Thin-section CT scans show extensive ground-glass opacities in the both lungs sparing peripheral regions.

Bronchovascular bundles are markedly thickened and interlobular septal thickening are also seen with fine subpleural micronodules.
Brief Review
This case shows extensive ground-glass opacity distributed at central lung, especially in peribronchovascular areas.

Other findings of perilymphatic distribution such as brochovascular bundle thickening, septal thickening, and subpleural nodules with hilar and mediastinal lymphadenopathy are helpful for the diagnosis of sarcoidosis.

Patchy areas of ground-glass opacity are sometimes seen in HRCT images of patients with sarcoidosis (1).

The results of correlation with pathologic specimen suggest that areas of ground-glass opacity usually are due to the presence of extensive interstitial sarcoid granulomas rather than alveolitis.

Ground-glass opacity are usually considered to correlate with disease activity as assessed by 67Ga scanning.

Sometimes, however, the ground-glass opacity does not decrease with the treatment of the disease. Brauner et al. (2) postulated that alveolar wall thickening due to fibrosis may be responsible for this pattern.
References
1. Webb WR, Muller NL, Naidich DP. High-resolution CT of the lung. 2nd ed. Lippincott-Raven.

2. Brauner MW, Lenoir S, Grenier P, et al. Pulmonary sarcoidosis: CT assessment of lesion reversibility. Radiology 1992; 182:349-354
Keywords
Lung, Mediastinum, Non-infectious inflammation, Sarcoidosis,

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