Pulmonary Sarcoidosis Presenting with Miliary Opacities

Abstract

Lung lesions often appear in patients with sarcoidosis; however, miliary opacities are rare. We herein report the case of a 40-year-old woman with pulmonary sarcoidosis who presented with dyspnea on exertion. Subsequent computed tomography showed miliary opacities, and the presence of granulomas was confirmed by a transbronchial lung biopsy. Glucocorticoid therapy was initiated and the symptoms and miliary opacities rapidly improved. Although miliary sarcoidosis is uncommon, physicians should consider sarcoidosis in addition to tuberculosis, malignancy, and pneumoconiosis when presented with miliary opacities.

Diffuse Lung Metastases in EGFR-Mutant Non-Small Cell Lung Cancer

“…Miliary nodular pattern of disease has distinct radiologic features characterized by diffuse, bilateral infiltration of the lungs by tiny, typically 1–4 mm in size, nodules likened to millet seeds [24]. This finding is seen in numerous infectious and inflammatory etiologies, including tuberculosis, histoplasmosis, silicosis, and sarcoidosis [25,26,27,28,29,30]. Miliary nodular patterns have also been in the setting of metastatic disease, most notably with primary thyroid cancer, renal cell carcinoma, and melanoma [24,25].…”

Seeds in the Lungs: A Pseudo-Miliary Pattern of Sarcoidosis

“…The Siltzbach classification system defines the typical radiographic pulmonary sarcoidosis manifestations and organizes it into five stages: stage 0, with no abnormality; stage 1, with only hilar lymphadenopathy; stage 2, with adenopathy and abnormal lung parenchyma; stage 3, with abnormal lung parenchyma only; and stage 4, with fibrotic changes [ 3 , 4 ]. The abnormal lung parenchyma is predominantly seen in the upper and middle lung fields [ 5 ]. In comparison, miliary nodules have a random distribution and there is no relation to the pleural surface, small vessels, and interlobular septa [ 2 ].…”

“…Miliary distribution is considered an atypical presentation of pulmonary sarcoidosis. It is rare and seen in less than 1% of cases [ 5 ]. Miliary sarcoidosis patients tend to be older with multiple comorbidities.…”

“…When encountering a case of miliary pattern on chest imaging, clinicians must first rule out other etiologies such as infection, metastatic malignancy, and autoimmune vasculitis like granulomatosis with polyangiitis, before diagnosing miliary sarcoidosis. Malignancy and tuberculosis spread hematogenously giving it a random miliary pattern [ 5 ]. A BAL can be used to differentiate between tuberculosis and sarcoidosis.…”

Miliary opacities in pulmonary sarcoidosis

“…C). The pattern of military opacities is rare in sarcoidosis (<1% of cases) but should be considered in the differential diagnosis, in addition to malignancy, tuberculosis, and pneumoconiosis .…”