Sarcoidosis

History:
35 year old CT chest with suspected TB

Mediastinal windows:

Lung windows:


Findings:
Multiple mediastinal nodes in the right paratracheal region. Numerous uniform shaped small lung nodules, deistributed predominantly in the upper and mid zones in the perihilar region with preivascular distribution. No fissural beeding.

Diagnosis:
Sarcoidosis

Discussion:
Differenitals for nodular lung lesions include sarcoidosis, eosinophilic granuloma, miliary tuberculosis and metastasis. Distribution of multiple small nodules in perivascular distribution with irregular thickening of bronchovascular bundles and interlobular septa in upper lobes and associated mediastinal lymphadenopathy strongly indicate sarcoidosis.
The present case is slightly unusual, because there is no fissural beeding and the mediastinal lymphnodes are not large.

References:
Koyama T et al. Radiologic Manifestations of Sarcoidosis in Various Organs. RadioGraphics 2004; 24: 87