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Figures for:
Computed Tomographic Scanning in Sarcoidosis

[Semin Respir Crit Care Med 24(4):393-418, 2003. © 2003 Thieme Medical Publishers]


Figure 1. Stage I sarcoidosis. Posteroanterior chest radiograph demonstrates bilateral hilar and right paratracheal lymphadenopathy. Lung fields are clear.

Figure 2. Stage II sarcoidosis. Posteroanterior chest radiograph demonstrates massive bilateral hilar lymphadenopathy as well as bilateral parenchymal infiltrates. Note the predilection for mid and upper lung zones. (Reproduced with permission from Lynch, Kazerooni.[93])

Figure 3. Stage II sarcoidosis. Extensive bilateral airspace opacities, which radiate out from the hilae. A nodular component can also be appreciated.

Figure 4. Sarcoidosis. Posteroanterior chest radiograph demonstrates extensive ground-glass, miliary infiltrates throughout both lung fields in a 22-year-old black female with a 4-month history of dyspnea. Transbronchial lung biopsies demonstrated confluent, noncaseating granuloma. Special stains and cultures for acid-fast bacilli and fungi were negative. Corticosteroids (prednisone 40 mg/day) led to dramatic improvement. (Reproduced with permission from Lynch, Kazerooni, Gay.[1])

Figure 5. (A) Nodular sarcoidosis. Posteroanterior chest radiograph reveals multiple dense alveolar nodular infiltrates in a 36-year-old woman. Bilateral hilar lymphadenopathy is also present. Transbronchial lung biopsies demonstrated confluent noncaseating granulomas consistent with sarcoidosis. The infiltrates resolved following institution of corticosteroid therapy. (B) Nodular sarcoidosis. Computed tomographic scan from the same patient demonstrates multiple, large, well-demarcated alveolar nodules in the left lower lobe. Areas of ill-defined alveolar consolidation with small nodules are also noted in the right lower lobe. (Reproduced with permission from Lynch, Kazerooni, Gay.[1])

Figure 6. (A) Nodular sarcoidosis. Chest computed tomography (CT) shows dense focal nodular infiltrates. Bilateral hilar lymphadenopathy is also present (arrows). Fiberoptic bronchoscopy demonstrated nonnecrotizing granulomas. (B) Chest CT scan from the same patient demonstrating focal alveolar nodular infiltrates.

Figure 7. High-resolution computed tomographic scan (1.5 mm collimation) in a patient with stage IV sarcoidosis demonstrates bulla formation, central bronchovascular thickening, and architectural distortion with rotation of the hila toward the spine. The lung interface with the pleura is irregular because of subpleural nodules. (Reproduced with permission from Lynch, Kazerooni, Gay.[1])

Figure 8. High-resolution computed tomographic scan from a 42-year-old man with sarcoidosis. Severe cystic radiolucencies in the upper lobes, with distortion and destruction of lung parenchyma; the anterior portions of the lungs are relatively spared. (Reproduced with permission from Lynch, Kazerooni.[93])

Figure 9. Severe fibrocystic sarcoidosis. Computed tomographic scan from a patient with severe, end-stage sarcoidosis. The right lung is virtually completely replaced by a bulla. The left lung shows thickened interlobular septa, scattered nodules, broad fibrous bands, and cystic radiolucencies.

Figure 10. High-resolution computed tomographic scan from a patient with chronic pulmonary sarcoidosis. Focal areas of traction bronchiectasis are present (see arrows).

Figure 11. High-resolution computed tomographic scan from a patient with chronic sarcoidosis at the level of lower lobes demonstrates thickened and dilated bronchial walls (arrows) consistent with bronchiectasis.

Figure 12. Stage IV sarcoidosis. High-resolution computed tomographic scan from a 44-year-old male with severe sarcoidosis. Focal nodular infiltrates, thickened bronchovascular bundles, and traction bronchiectasis are evident. A cavitary lesion is present in the right (arrow) upper lobe. Note the left-sided (arrow) pneumothorax.

Figure 13. Sarcoidosis with mycetoma. Posteroanterior chest radiograph demonstrates a mycetoma in the left upper lobe. (Reproduced with permission from Lynch, Kazerooni, Gay.[1])

Figure 14. Computed tomographic scan. Severe cystic radiolucencies in upper lobes in a patient with end-stage sarcoid. Note the mycetoma (arrow). (Reproduced with permission from Lynch, Kazerooni.[93])

Figure 15. (A) Chest computed tomographic (CT) scan from a patient with stage I sarcoidosis at the level of the carina shows extensive para-aortic lymph node enlargement (arrows). (B) Chest CT scan from the same patient following intravenous contrast. Bilateral hilar lymphadenopathy and marked widening of the carina due to enlarged subcarinal lymph nodes (arrow) are present.

Figure 16. Sarcoidosis. Computed tomographic scan from a 36-year-old woman with chronic sarcoidosis demonstrates calcified mediastinal right paratracheal lymph nodes. (Reproduced with permission from Lynch, Kazerooni.[93])

Figure 17. Pulmonary sarcoidosis with nodular consolidation. Note dense focal alveolar opacities emanating from the hilae.

Figure 18. Sarcoidosis. High-resolution computed tomographic scan at the level just below the main hilum shows extensive infiltrates with consolidation radiating from the hilar regions. Numerous parenchymal nodules are also present. Bilateral hilar adenopathy was also present.

Figure 19. Sarcoidosis. High-resolution computed tomographic scan shows extensive perihilar infiltrates, scattered parenchymal nodules, and thickened bronchovascular bundles.

Figure 20. High-resolution computed tomographic scan from a 58-year-old woman with severe sarcoidosis. Severe cystic radiolucences with a proclivity for the bronchovascular bundles; both hilae are enlarged. Not the distribution of the cystic lesions around the hilae. (Reproduced with permission from Lynch, Kazerooni.[93])

Figure 21. (A) High-resolution computed tomographic (HRCT) scan from a 50-year-old male with sarcoidosis at the level of the carina demonstrates perihilar infiltrates, thickened bronchovascular bundles, and parenchymal nodules. (B) HRCT from the same patient demonstrates dense consolidation contiguous with the right hilum and innumerable nodules.

Figure 22. (A) High-resolution computed tomographic (HRCT) scan from a 45-year-old male with sarcoidosis at the level of the main carina showing innumerable parenchymal nodules and thickened bronchovascular bundles. Transbronchial lung biopsies showed nonnecrotizing granulomas, consistent with sarcoidosis. (B) HRCT from the same patient demonstrates innumerable focal parenchymal nodules. In addition, there are thickened lines emanating from the right hilum along the bronchovascular bundles (see arrow).

Figure 23. Sarcoidosis. High-resolution computed tomographic scan demonstrates numerous small nodules, with a predilection for bronchovascular bundles.

Figure 24. (A) Stage II sarcoidosis. Chest radiograph from a 48-year-old man demonstrates multiple focal nodular infiltrates throughout both lung fields and extensive bilateral hilar lymphadenopathy. (B) High-resolution computed tomographic (HRCT) scan from a 48-year-old man demonstrates multiple distinct nodules (see arrows) in addition to parenchymal infiltrates. ((A) and (B) Reproduced with permission from Lynch.[3]) (C) HRCT scan from the same patient demonstrates dense alveolar opacities radiating from the hilar regions bialterally; several well-defined nodules are present in the lung parenchyma (arrows).

Figure 25. (A) Nodular sarcoidosis. High-resolution computed tomographic (HRCT) scan from a 38-year-old male with sarcoidosis demonstrates widened carina (consistent with subcarinal lymphadenopathy), left hilar lymph node enlargement, and an alveolar, masslike lesion emanating from the left hilum. (B) HRCT scan from the same patient demonstrates dense focal, alveolar opacities. Transbronchial lung biopsies confirmed nonnecrotizing granulomas.

Figure 26. High-resolution computed tomographic (HRCT) scan from a 62-year-old woman with sarcoidosis demonstrates widespread nodular and miliary lesions. Transbronchial lung biopsies demonstrated numerous nonnecrotizing granulomas. Special stains and cultures for acid-fast bacilli and fungi were negative. Three months after institution of corticosteroid therapy, the HRCT had normalized. (Reproduced with permission Lynch, Kazerooni.[93])

Figure 27. High-resolution computed tomographic image (1.5 mm collimation) of a 36-year-old man demonstrates bronchovascular thickening involving the axial interstitium and small ill-defined pulmonary nodules beginning to colaesce in the upper lobes with the most confluent disease in the central portion of the lungs. Air-bronchograms are also apparent within the consolidated mass lesions. The lower lobes were less severely diseased. (Reproduced with permission from Lynch, Kazerooni, Gay.[1])

Figure 28. Pulmonary sarcoidosis. High-resolution computed tomographic scan demonstrates two areas of dense focal consolidation.

Figure 29. Sarcoidosis with consolidation: High-resolution computed tomographic scan demonstrating focal consolidation with air-bronchograms contiguous to the right hilum (arrow).

Figure 30. Sarcoidosis. High-resolution computed tomographic scan demonstrates focal consolidation with air-bronchogram (arrow).

Figure 31. Sarcoidosis. High-resolution computed tomographic scan from lower lobes demonstrates focal zones of consolidation, scattered nodules, and thickening of the bronchovascular bundles. Note the air-bronchogram within a zone of consolidation (arrow).

Figure 32. High-resolution computed tomographic scan from a 48-year-old male with pulmonary sarcoidosis demonstrates dense alveolar opacity contiguous to hilum (arrow) with air bronchograms; multiple nodules are present in both lungs. (Reproduced with permission from Lynch, Kazerooni.[93])

Figure 33. (A) High-resolution computed tomographic (HRCT) scan at the level of the carina from a 44-year-old woman with chronic sarcoidosis. Thick linear bands (arrows), focal consolidation, and nodules are present. (B) HRCT from the same patient from the lower lobes. Note dense perihilar zones of dense consolidation. A few nodular granulomatous lesions are also present. (C) HRCT from the same patient at the extreme lung bases. A few nodular densities are present but much of the lung parenchyma is preserved. A thick fibrotic band is also present (arrow).

Figure 34. (A) Cystic pulmonary sarcoidosis. High-resolution computed tomographic (HRCT) scan from lung apices demonstrates focal cystic radiolucencies, scattered parenchymal nodules, and an area of alveolar consolidation with thickened bronchovascular bundles (arrow). (B) HRCT from the same patient at a level just below the carina demonstrates large cystic lesions (white arrows) and dense perihilar alveolar nodular consolidation and thickened bronchovascular bundles (black arrows). (C) HRCT from the same patient. Alternating zones of low- and high-attenuation areas consistent with a mosaic pattern of perfusion. In addition, focal areas of consolidation are present in the right lung (black arrow). Thickened septal lines are also evident (white arrow). (D) HRCT from the same patient at the extreme basilar regions of the lungs. Patchy areas of ground-glass opacities and a few scattered nodules are present.

Figure 35. (A) Severe sarcoidosis. High-resolution computed tomographic (HRCT) scan at the level of the apices demonstrates thickened interlobular septa, broad fibrous bands, and cystic radiolucencies. (B) Sarcoidosis. HRCT from the same patient at the level of the main carina demonstrating extensive cystic changes and both septal and nonseptal lines. Bilateral hilar lymphadenopathy was also present. (C) HRCT from the same patient demonstrates thickened bronchovascular bundles, thickened bronchial walls, septal lines, early cystic changes, and some ground-glass opacities.

Figure 36. Computed tomographic image (5 mm collimation) from a patient with stage IV sarcoidosis demonstrates extensive cystic destruction and honeycomb formation that was further localized in the posterior aspects of the upper lobes. (Reproduced with permission from Lynch, Kazerooni, Gay.[1])

Figure 37. Bullous (cystic) sarcoidosis. High-resolution computed tomographic scan from 37-year-old male with severe sarcoidosis demonstrates virtually complete replacement of the right upper lobe with a bulla (arrow). Left lung demonstrates a few thickened septal and nonseptal lines and scattered nodules.

Figure 38. Stage IV sarcoidosis. Extensive cystic radiolucencies throughout both upper lobes.

Figure 39. High-resolution computed tomographic scan in a patient with sarcoidosis demonstrates extensive cysts in the upper lobes; a few scattered nodules are present in the right lung.

Figure 40. Stage IV sarcoidosis. High-resolution computed tomographic scan shows extensive parenchymal distortion and destruction. Multiple honeycomb cysts are noted throughout the upper lobes bilaterally. (Reproduced with permission from Lynch, Kazerooni, Gay.[1])

Figure 41. High-resolution computed tomographic scan. End-stage sarcoidosis with virtually complete replacement of upper lobes with cystic radiolucencies. (Reproduced with permission from Lynch, Kazerooni.[93])

Figure 42. (A) High-resolution computed tomographic (HRCT) scan at the level of the apices from a patient with sarcoidosis showing severe cystic radiolucencies. Much of the lung parenchyma is preserved. Note the axial distribution of the cysts, radiating from the central regions of the lung. (B) HRCT from the same patient at the level of the carina showing extensive cystic changes. A few parenchymal nodules are also present. (C) HRCT scan from the same patient at the level of the lower lobes demonstrated cystic radiolucencies and marked thickening of bronchovascular bundles, particularly on the right (arrow). (D) HRCT scan from the same patient shows dilated, thickened bronchi consistent with traction bronchiectasis (arrows).

Figure 43. High-resolution computed tomographic scan. Severe cystic radiolucences with a proclivity for the bronchovascular bundles; note the mycetoma in the right lung (arrow). (Reproduced with permission from Lynch.[3])

Figure 44. Sarcoidosis with mycetoma. Extensive cystic radiolucencies virtually replacing the right upper lobe. A mycetoma is present (arrow points to crescent sign).

Figure 45. Sarcoidosis with mycetoma. High-resolution computed tomographic scan demonstrates focal areas of consolidation radiating outward from both hilae, scattered nodules, and a mycetoma within a cavity (arrow).

Figure 46. Sarcoidosis with mycetoma. Extensive cysts are evident in right upper lobe. Note mycetoma in left upper lobe (arrow).

Figure 47. High-resolution computed tomographic scan from a patient with usual interstitial pneumonia complicating rheumatoid arthritis. Numerous honeycomb cysts are present. Note the patchy nature of the disease and the subpleural distribution.

Figure 48. Langerhans' cell granulomatosis (pulmonary eosinophilic granuloma). Extensive cystic lesions involving upper lobes; a nodular component co-exists but is subtle.

Figure 49. (A) Langerhans' cell granulomatosis (pulmonary eosinophilic granuloma). High-resolution computed tomographic (HRCT) scan at the level of the upper lobes demonstrates multiple cystic spaces, with coalescence. (B) HRCT from the same patient demonstrates multiple nodules, thickening of bronchial walls, and multiple cysts, with areas of confluence. ((A) and (B) Reprinted with permission from Lynch, Keane.103) (C) Langerhans' cell granulomatosis (pulmonary eosinophilic granuloma). HRCT from the same patient (at the level of the carina) demonstrates multiple nodular lesions, thickened bronchial walls, and a few cavitary lesions. (Reproduced with permission from Lynch, Myers.[104])

Figure 50. (A) Lymphangioleiomyomatosis. Computed tomographic scan in a 44-year-old woman demonstrates multiple thin-walled cystic radiolucencies bilaterally. Note the two large lesions, representing confluent cysts (arrows). (Reproduced with permission from Lynch, Raghu.[111]) (B) Lymphangioleiomyomatosis. High-resolution computed tomographic scan from the same patient shows innumerable thin-walled cysts, which are diffuse throughout the lung parenchyma.

Figure 51. Acute extrinsic allergic alveolitis [hypersensitivity pneumonia (HP)]. High-resolution computed tomographic scan from a 59-year-old woman with fever, cough, and dyspnea demonstrates focal ground-glass opacities with a peribronchiolar distribution. Transbronchial lung biopsies demonstrated foamy macrophages, dense lymphocytic infiltrates, and poorly formed granulomas, consistent with acute HP. The disease cleared completely following institution of corticosteroids and avoidance of further exposure to molds. (Reproduced with permission from Kuru, Lynch.[116])

Figure 52. (A) Sarcoidosis involving the brain. MRI scan. Multiple gadolinium-enhancing lesions are present (see arrows). (B) Sarcoidosis involving the brain. MRI scan from the same patient. Multiple gadolinium-enhancing lesions are present.

Figure 53. Sarcoidosis involving the brain. MRI scan. Large arrow depicts a large mass lesion in the medial aspect of the right frontal lobe that enhances with gadolinium. Considerable edema in the frontal lobe surrounds the mass lesion. A smaller lesion (arrow) is also evident. The lesions regressed with corticosteroid therapy. (Reprinted with permission from Lynch, Baughman, Sharma.[4])

Figure 54. Sarcoidosis involving the spleen. Large multinucleated giant cell (arrow) and granulomatous inflammation within the spleen in a 30-year-old black woman with marked splenomegaly.

Figure 55. (A) Sarcoidosis involving the spleen. Computed tomographic scan demonstrated multiple low attenuation lesions in the spleen. Because of refractory splenic pain in spite of maximal medical therapy, splenectomy was performed. (B) Sarcoidosis involving the spleen. Resected spleen from the same patient demonstrating innumerable macroscopic nodules. Histopathological examination revealed coalescent nonnecrotizing granulomas.