DISTINCTIVE MANIFESTATIONS OF PULMONARY SARCOIDOSIS ON HIGH RESOLUTION COMPUTED TOMOGRAPHY

Abstract

Sarcoidosis is a multisystem granulomatous disorder with unknown etiology, poorly understood pathogenesis and variable prevalence. As already mentioned, it can affect any system or organ, but most frequently resides in the lungs, mediastinal and hilar lymph nodes, it is characterized by the presence of non- caseating granulomas, and its diagnosis typically requires histopathological proof. Sarcoidosis is a great mimicker of various thoracic disorders and its evolution and severity are highly variable, ranging from asymptomatic and self- limiting to highly debilitating with development of progressive thoracic disease and cardio- vascular complications, requiring long term therapy. This study aims to establish a proper and efficient diagnostic approach, give an overview of the typical radiological manifestations of sarcoidosis on high resolution computed tomography (HRCT) and reduce the differential uncertainty. We thoroughly analyzed 20 HRCT scans of patients diagnosed with sarcoidosis, with mean age of 38.8± 6.91(25 to 51 years old) of both genders. All 20 patients underwent HRCT according to appropriate diagnostic protocol on a 128- slice computed tomography (Siemens Healthineers, USA). The most frequent findings were bilateral and symmetrical hilar and right para- tracheal lymphadenopathy, often accompanied by parenchymal abnormalities such as multiple small nodules in a peribronchovascular distribution and irregular interstitial thickening. We also encountered some atypical thoracic findings such as asymmetrical lymph node involvement, large alveolar opacities, ground glass opacities and pleural involvement. High Resolution Computed Tomography is an important diagnostic tool in the accurate evaluation and depiction of many typical and atypical lung parenchymal and extra- parenchymal findings in sarcoidosis, offers the possibility to establish reasonable differential diagnosis, and at the same time, estimates the severity of the parenchymal involvement and predicts future complications.