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Hoon Shin

 

Hi Hoon

Re “Sarcoidosis, a Scare, Chest Pain and an Octopus”

This is a story about a 59 year  old woman who had sarcoidosis, who had a scare developed chest pain that sounded like acute coronary syndrome and was short of breath

Your part is to teach about Sarcoidosis on Chest CT and it is now posted on this page

Almost done streamlining  your part

The key I think is to know and teach that sarcoidosis and the lymphatic system go hand in hand – Secondly that sarcoidosis loves to coalesce – granulomas become micronodules – which cluster and coalesce (good buzz words) and things get bigger and more dense downstream by the hila

Also the parallel of the pathogenesis is similar in the heart – See Pedro’s presentation

Thanks for your help

Let me know about any reservations

Thanks

AD

In a Nutshell

    • Upper Lobe Predominance
    • Follow Lymphatics (Go with the flow) starting at
      • Pleural and Fissural then
      • Centrilobular and Interlobular Septa
      • Central lymphatics and then
      • Central Lymph Nodes (Egg Shell)
    • Nodules that Cluster

THE ?S? OF SARCOIDOSIS

Sarcoidosis is a nodular granulomatous disease which predominates in the upper lobes and has its epicenter in the lymphoid tissue of the lungs.
The ?S? for sarcoidosis drawn on the thoracic cage outlines the lymphatic distribution of the lungs, starting  superficially in the pleura involving the lymphatic system in the pleura, and then flowing downstream into the interlobular septa, bronchovascular bundles and lymph nodes

?S? of SARCOIDOSIS 

Pathogenesis of morphological changes along the “S” shaped sarcoidosis  Curve

 

The Granulomas

    • The granulomas start as micronodules in close association with the lymphatics (1) spread in the intralobular septa and centrilobular bronchioles (2) cluster and conglomerate to form macro nodules (4,5) sometimes manifesting as the galaxy sign (6). As they progress centrally the granulomatous changes extend along fissure and bronchovascular bundles (8,9) manifest as thickening and or nodularity.   The granulomatous disease continues to cluster and conglomerate becoming mass like along the pathway (7), most commonly centrally as the lymphatics become confluent in the hila (7)
      The lymph nodes in the mediastinum become significantly enlarged and fleshy (10). They often calcify (12) sometimes on the calcify on the rim of the node (eggshell calcification (11)

 

Nodules in the Secondary Lobules

132090.8.jpg

CT WITH SUBPLEURAL AND LYMPHOVASCULAR NODULES IN THE RIGHT UPPER LOBE ? INTERLOBULAR SEPTA AND CENTRILOBULAR
Ashley Davidoff MD

Pleura and Subpleural Disease Thickening and Nodularity

CT WITH SUBPLEURAL AND LYMPHOVASCULAR NODULES IN THE LEFT UPPER LOBE
Ashley Davidoff MD

Fissural Involvement
SARCOIDOSIS  FISSURAL INVOLVEMENT
Ashley Davidoff MD
Micronodules, Nodules, Coalescence and the Galaxy Sign
GALAXY SIGN
Parenchymal nodules and micronodules sometimes coalesce to form a central confluent mass with surrounding micronodules, described as the galaxy sign.
Ashley Davidoff MD
CT WITH GALAXY SIGN
Ashley Davidoff MD
GALAXY SIGN
Thickening around the Airways

When the nodularity, clustering and or mass formation involves the lymphatics around the terminal bronchioles it results in centrilobular micronodules, and when it involves the larger airways it causes thickening and nodularity

 

CT WITH SUBPLEURAL AND BRONCHOVASCULAR NODULES IN THE RIGHT UPPER LOBE
Ashley Davidoff MD

Lymphadenopathy
Paewnbrokers Sign

CT with MEDIASTINAL AND HILAR ADENOPATHY
Pawnbroker?s Sign
Ashley Davidoff MD

  • SARCOIDOSIS AND EGG SHELL CALCIFICATION OF LYMPH NODES
    Ashley Davidoff MD
SUMMARY
CT OF SARCOIDOSIS
GIF FILENext Pedro  Staziaki,