1. JK Amorosa

2. Sarcoidosis, where does the name come from?  Sarc: flesh  Oid : like  Flesh-like  Besnier-Boeck-Schauman Disease

3. Sarcoidosis–symptoms & findings Asymptomatic Fatigue Weight loss Aches-pains Arthritis Dry eyes SOB Erythema nodosum Enlarged lymph nodes Rashes Erythema nodosum Hepatomegaly Arrythmias Anemia Nerve palsy Parotid enlargement Abnormal Vitamin D regulation

4. Sarcoidosis - pathology  Chronic inflammatory cells: monocytes, macrophages, activated T-lymphocytes form granulomas  Systemic inflammatory disease

5. Lofgren Syndrome – good prognosis  Bilateral adenopathy  Erythema nodosum  Arthralgia

6. Imaging Summary Initial imaging for the diagnosis of sarcoidosis is Chest X- Ray.  HRCT can provide better resolution of lung findings  Radiographic Stages of disease progression  Stage 0: Normal CXR  Stage 1: bilateral hilar/mediastinal adenopathy  Stage 2: bilateral hilar /med adenopathy and pulmonary opacities  Stage 3: Diffuse pulmonary opacities alone  Stage 4: Diffuse pulmonary fibrosis

7. Paradoxical effect on inflammatory process – ANERGY ? related to increased risk of cancer and infections  HYPER Increase inflammation because of increased macrophages, CD4 helper T cell activation  HYPO Immune response to antigen challenges such as tuberculin is decreased

8. What is Schauman body?  Calcium and protein inclusions in Langhans giant cell in a granuloma

9. Asteroid body Granuloma

10. Imaging characteristics  Normal  Symmetrical smooth bilateral hilar and mediastinal adenopathy  Lung, early stages: perifissural, peribronchial nodules, miliary nodules, patchy focal opacities  Lung, late stages: distortion, atelectasis, cavities, bronchiectasis

11. a.m. 3-19-12

12. am 9-13-11

13. Bilateral hilar and mediastinal adenopathy,Stage II, Ddx:  Lymphoma  Small cell ca lung  TB

14. jf

16. 72 m

17. Small cell ca with mediastinal adenopathy and pericardial mets

19. Sarcoidosis

20. Imaging Findings  Bilateral  Peripheral, subpleural/peri- bronchovascular, mid and lower lung zone  Basal patches of consolidation  migratory

21. Jf Adenopathy, fine nodular process, some along fissures

22. 35 f

24. HRCT  Consolidation  GG  Nodules  Reticular pattern  Bronchial wall thickening and/or dilitation  SPN  Perilobular pattern  Reverse halo  Honeycomb

25. 27 yo f c SOB

26. Ddx: mets, vasculitis, Sarcoidosis

27. 29 yo f c fever

28. Sarcoid, septic infarcts

30. CMV Pneumonia

32. cocaine

34. Chronic eosinophilic pneumonia

37. Acute hypersensitivity Pneumonia

38. Atoll

39. Lung, stage IV Ddx:  Complicated silicosis  Radiation fibrosis

40. jd.

41. 66

42. 66 Calcified hilar nodes, atelectatic, bronchiectatic lung changes

44. Dx: PMF, Conglomerate mass

45. 62 f fever

47. Fungus ball, sarcoid

48. 31 f

52.  Describe findings, procedures

53. DDX:  Lymphoma  BAC  Chronic Eosinophilic Pneumonia  Lung ca  Aspiration Pneumonia  Lipoid Pneumonia  PE  Sarcoid

54. HRCT  Consolidation  GG  Nodules  Reticular pattern  Bronchial wall thickening and/or dilitation  SPN  Perilobular pattern  Reverse halo  Honeycomb

55. DDX:  Lymphoma  BAC  Chronic Eosinophilic Pneumonia  Lung ca  Aspiration Pneumonia  Lipoid Pneumonia  PE  Sarcoid

56. BOOP= Polypoid plugs of loose granulation tissue within air spaces

57. References  H Prabhakar, C Rabinowitz, F Chew AJR. 2008;190: S1-S6. 10.2214/AJR.07.7001  G Boitsios et al AJ R 2010;194: W354-W366. 10.2214/AJR.10.4345