Radiology Presentation Ashton Lai
MS4 2/21/2018
H&P
• MR965617
• 56y/oF w/ HTN, DM2, OSA p/w dry cough x 2 wks, palpitationsand right lower leg pain
Right Lower Leg
4/2015 right leg: MICROSCOPIC DESCRIPTION: The specimen consists of epidermis and dermis. Sections show a dermal inflammatory infiltrate including relatively scant lymphocytes and epithelioid histiocytes arranged in well-defined granulomas. Giant cells are seen. There are not prominent epidermal changes. Polarization is negative. There is slight hyperorthokeratosis with a slightly diminished granular cell layer.
Clinical Features
• Pulmonary, Cardiac, Musculoskeletal (arthralgias, etc), CNS (palsies, endocrine, etc) • Lofgren’s syndrome:
1) EN 2) hilar adenopathy 3) Arthritis
Radiographic Features
• Galaxy Sign • Garland’s Triad (1-2-3 sign):
1) Right paratracheal nodes 2) Right hilar nodes 3) Left hilar nodes
• Panda’s Sign
Radiographic Staging
• stage 0: normal chest radiograph • 5-10% of patients at presentation
• stage I: hilar or mediastinal nodal enlargement only • 45-65% of patients at presentation
• stage II: nodal enlargement and parenchymal disease • 25-30% of patients at presentation
• stage III: parenchymal disease only • 15% of patients at presentation
• stage IV: end-stage lung (pulmonary fibrosis)
H&P
• MR965617
• 56y/oF w/ HTN, DM2, OSA p/wdry cough x 2 wks, palpitations and right lower leg pain
• Failed on just prednisone • Now on methotrexate and prednisone
• w/u for cardiac sarcoid (MRInegative) and f/u w/ optho
Cardiac MRI • Increased signal intensity on T2-weighted MRI 2/2 edema (a) • Delayed enhancement reflecting accumulation of Gd chelates intissue • Focal myocardial thickening
References
• https://radiopaedia.org/articles/pulmonary-sarcoidosis-staging-on-chest-radiograph • https://emedicine.medscape.com/article/361490-overview • American Journal of Roentgenology. 2005;184: 249-254.10.2214/ajr.184.1.01840249 https://www.ajronline.org/doi/full/10.2214/ajr.184.1.01840249