Thoracic Sarcoidosis

Radiologic-Pathologic Correlation

Abstract Introduction Clinical Features Pathologic Features

Staging Radiologic Characteristics Complications Extrapulmonary Thoracic Manifestations

Differential Diagnosis Treatment and Prognosis Source Information References

Complications

The three major complications of pulmonary sarcoidosis are fibrosis, cor pulmonale, and mycetoma formation (3,8,12,33,34). Stage IV sarcoidosis or lung fibrosis results in radiographic findings of hilar retraction, decreased lung volume, and honeycomb lung. Bullae, air trapping, and diaphragmatic tenting can also be seen (Figure 6d, Figure 13).

Extensive interstitial fibrosis can cause pulmonary arterial hypertension and resultant right heart failure. Radiographic findings include a prominent main pulmonary artery, enlarged right and left pulmonary arteries, right ventricular enlargement, and attenuation of peripheral vessels (33,35,36).

Saprophytic fungal colonization, usually by Aspergillus species, occurs in more than 50% of patients with stage IV sarcoidosis and apical bullous disease (34, 37). The earliest manifestations of mycetoma formation are adjacent pleural thickening or apparent thickening of the wall of a bulla (Figure 23). Later, an intracavitary, gravity dependent-mass (Mounod sign) may be seen (Figure 24, Figure 25). Although mycetomas may be clinically silent, hemoptysis is quite common. Life-threatening hemoptysis that requires surgical intervention or angiographic localization of bleeding with concurrent bronchial artery embolization occurs in a minority of patients (12,34).

Abstract Introduction Clinical Features Pathologic Features

Staging Radiologic Characteristics Complications Extrapulmonary Thoracic Manifestations

Differential Diagnosis Treatment and Prognosis Source Information References