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Weekly Chest CasesArchive of Old Cases

Case No : 533 Date 2008-01-14

  • Courtesy of Song Choi, MD, Hyun-Ju Seon, MD, Yun-Hyeon Kim, MD. / Chonnam National University Hospital, Korea.
  • Age/Sex 24 / M
  • Chief ComplaintAbnormal findings on CXR
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Sarcoidosis (Sarcoid Galaxy sign)
Radiologic Findings
Figs 1. Chest PA shows multiple patchy infiltrations in right upper and mid lung zones and bilateral hilar bulging contour.
Fig 2-4. Lung window setting of the chest CT scan shows multiple patchy areas of aggregated tiny nodules including subpleural and peribronchovascular interstitial nodules in RUL and segmental area of peribronchial GGO, fine reticulonodular densities, and nodular consolidation in lateral segment of RML.
Figs 5-6. Mediastinal window setting of the chest CT shows multiple conglomerate lymphadenopathies with relatively homogeneous low attenuation in mediastinum including subcarinal area, both hila, and both interlobar nodal areas.
Brief Review
Sarcoidosis is a systemic disorder of unknown cause characterized by the presence of noncaseating granulomas.
Although small parenchymal nodules along the bronchoarterial bundles, interlobular septa, and major fissures and in the subpleural regions are frequently observed in pulmonary sarcoidosis on CT, large nodules (≥1 cm in diameter) are less common.
Sarcoid galaxy sign is the term of characteristic appearance of large parenchymal nodules resembled as galaxy that is a vast collection of millions and occasionally billions of stars. The large parenchymal nodules consisted of numerous small nodules and showed irregular margins. In the periphery of the large nodules, each constituent small nodule had a relatively distinct margin.
Pathologically, the sarcoid galaxy of the large nodule represents innumerable coalescent granulomatous lesions. Toward the center of the sarcoid galaxy, granulomas were much more concentrated than in its periphery. Peripheral low-attenuation spots corresponded to the spaces between partially coalescent small nodules.
References
1. Nakatsu M, Hatabu H, Morikawa K, Uematsu H, Ohno Y, Nishimura K, Nagai S, Izumi T, Konishi J, Itoh H. Large coalescent parenchymal nodules in pulmonary sarcoidosis: "sarcoid galaxy" sign. AJR Am J Roentgenol. 2002;178:1389-1393
Keywords
Lung, Mediastinum, Non-infectious inflammation, Sarcoidosis,

No. of Applicants : 55

▶ Correct Answer : 34/55,  61.8%
  • - Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Shiga University of Medical, Japan Norihisa Nitta
  • - CHRU Lille hopital calmette, France Toledano Manuel
  • - Trakya University Edirne, Turkey Armagan Sarac
  • - Osaka University, Japan Osamu Honda
  • - Bollineni superspeciality hospital nellore, India Jignesh Dubal
  • - National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
  • - Kyung Hee university medical ceneter, Seoul, Korea Moon Sung Kyoung
  • - CHU Grenoble France Pierre Yves Savoye
  • - Maimonides Medical Center; Brooklyn, N.Y., U.S.A. Naomi Twersky
  • - China Medical University, Taiwan Jun-Jun Yeh
  • - Shinsegye Rad Clinic, Daegu, Korea Gi Beom Kim
  • - Gimpo Woori Hospital, Korea Son Youl Lee
  • - Mokpo Hankook Hospital, Korea Sang Uk Park
  • - Annecy hospital, France Gilles Genin
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Vitalife Clinics, Pune, India Rahul Deshmukh
  • - Pulmonologist, Medical College Chest Hospital, Thrissur, Thrissur, India Raveendran T.K
  • - Hospital Sotiria, Athens, Greece Vasilios Tzilas
  • - Armed Forces ChunCheon Hospital (AFCC), Korea Chae Hun Lim
  • - Medinova Diagnostics, Bheemavaram, AP., India Harsha Vardhan
  • - Dongguk University International Hospital, Korea Hee Seok Choi
  • - IRSA La Rochelle, France Jean-Luc BIGOT
  • - Annecy, France Antoine Marie
  • - Nour El-Islam Radiology Center, Alexandria, Egypt Elsayed Mousa
  • - IRSA, La Rochelle, France Denis Chabassiere
  • - Bollineni Hospital, Nellore, AP. India CH. Madhusudhan
  • - Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
  • - E-Da Hospital, Taiwan Yu-Feng Wei
  • - University of Virginia, USA Rachita Khot
  • - Ondokuz Mayis University, Samsun Turkey Cetin Celenk
  • - Aims, New Delhi, India Ashish Gupta
  • - CHU Grenoble, France Fabrice Bing
  • - Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
▶ Correct Answer as Differential Diagnosis : 14/55,  25.5%
  • - UHL NHS Trust, UK A. Donuru
  • - Armidale Radiology, Australia Saurabh Khandelwal
  • - Pittwater Radiology, Australia Julie Arora
  • - Lilavati Hospital & Rsearch Centre, Mumbai, India Mahavir Swami
  • - Ryby hall clinic Pune, India sudarshan Rawat
  • - KAUMS, Kashan, Iran Ebrahim Razi
  • - Pan-Chiao Cathay Hospital, Korea Shih-chang Lin
  • - Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
  • - Oswal Cancer Hospital, Ludhiana, Punjab, India Lovkesh Mittal
  • - Homs National Hospital, Homs - Syria Rami Abou Zalaf
  • - Jackson Memorial Hospital, Miami, Florida, USA N.B.S. Mani
  • - Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
  • - Vital imaging centre, Mumbai, India Ganesh Agrawal
  • - Ultra Care Coimbatore, India Debabrata Das
▶ Semi-Correct Answer : 7/55,  12.7%
  • - Regional Imaging Riverina, Australia Rashid Hashmi
  • - Inha University Hospital, Korea Yoon mi Lee
  • - Anandnagar, Hingne Khurd, Pune, India Bankim J. Amin
  • - Sharma Clinic, Jaipur, India Dinesh Sharma
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - EKH-Berlin, Germany Michael Weber
  • - Nassau, Bahamas Trupti Dabholkar
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