Pulmonary sarcoidosis: the ‘Great Pretender’

Hawtin, K.E.; Roddie, Mary E.; Mauri, Francesco; Copley, Susan J.

doi:10.1016/j.crad.2010.03.004

Cited by 42 publications

(25 citation statements)

References 48 publications

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“…This suggests that it is difficult to interpret the modes of spread of small nodules using high-resolution CT, such as perilymphatic (common in sarcoidosis) or transbronchial (typically recognized as the tree-in-bud sign, suggestive of TB). In terms of correlation between pathology and radiological signs, the "galaxy" sign usually has an aggregation of numerous coalescent small nodules centrally presented as a large nodule, whereas the peripheral area usually has partially coalescent small nodules corresponding to peripheral low-attenuation spots on CT [1,5], as seen in our case ( Fig. 1B, C, arrow heads).…”

Section: Discussionsupporting

confidence: 57%

Multiple huge “cluster” and “galaxy” signs on chest radiography in a patient with pulmonary tuberculosis

Oda

Saraya

Shirai

et al. 2019

Respirology Case Reports

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A 62‐year‐old healthy man presented to our hospital due to a persistent fever of up to 38°C for one week. Thoracic computed tomography showed right pleural effusion with multiple large nodules up to 7 cm in diameter composed of numerous discrete small nodules like fireworks, the so‐called “cluster” signs. Some of the large nodules had a hyper‐dense portion centrally surrounded by partially discrete small nodules, not as densely assembled, suggestive of the “galaxy” sign. The repeated acid‐fast sputum smears and both bronchial washings were all negative for Mycobacterium tuberculosis, but the acid‐fast culture of sputum taken soon after the first bronchoscopy, and pleural fluid, turned out to be positive for M. tuberculosis at six weeks after admission. The present case clearly demonstrates that the “galaxy” and “cluster” signs are red herring signs of the low rates of isolating M. tuberculosis, which should be differentiated from pulmonary sarcoidosis.

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Section: Discussionsupporting

confidence: 57%

Multiple huge “cluster” and “galaxy” signs on chest radiography in a patient with pulmonary tuberculosis

Oda

Saraya

Shirai

et al. 2019

Respirology Case Reports

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“…Usually advanced pulmonary sarcoidosis causes a restrictive functional deficit due to fibrosis. On the other hand, the granulomas developing in centrilobular and peribronchiolar lymphatics frequently involve small airways; thus, evidence of air-trapping is considered a common feature of the disease [29]. …”

Section: Reviewmentioning

confidence: 99%

Expiratory CT scan in patients with normal inspiratory CT scan: a finding of obliterative bronchiolitis and other causes of bronchiolar obstruction

Gaeta

Minutoli

Girbino

et al. 2013

Multidiscip Respir Med

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Expiratory CT scan is usually obtained as supplement to normal inspiratory CT scan to recognize air-trapping, which is expression of small airways obstruction. In some patients the air-trapping may be the only sign of an early-stage small airways disease in an otherwise normal lung.The purpose of this article is to illustrate pathologic conditions, namely obliterative bronchiolitis, in which expiratory CT scan can be abnormal despite normal inspiratory CT examination, and to highlight indications for this technique in patients with clinical and functional suspect of bronchiolar obstruction.

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“…Actually sarcoidosis is a great mimic of any pattern since it may present with many different forms. When it is manifested with septal pattern—as the predominant pattern—it may also exhibit intralobular thickening, linear opacities and perilymphatic distribution of micronodules that may add to the nodular thickening of the interlobular septae [7, 8]. There is usually an upper/middle and central/perihilar predominance in sarcoidosis (Fig.…”

Section: Hrct Patternsmentioning

confidence: 99%

Mimics in chest disease: interstitial opacities

Oikonomou

Prassopoulos

2012

Insights Imaging

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Septal, reticular, nodular, reticulonodular, ground-glass, crazy paving, cystic, ground-glass with reticular, cystic with ground-glass, decreased and mosaic attenuation pattern characterise interstitial lung diseases on high-resolution computed tomography (HRCT). Occasionally different entities mimic each other, either because they share identical HRCT findings or because of superimposition of patterns. Idiopathic pulmonary fibrosis (IPF), fibrosis associated with connective tissue disease, asbestosis, end-stage sarcoidosis or chronic hypersensitivity pneumonitis (HP) may present with lower zone, subpleural reticular pattern associated with honeycombing. Lymphangiomyomatosis may be indistinguishable from histiocytosis or extensive emphysema. Both pulmonary oedema and lymphangitic carcinomatosis may be characterised by septal pattern resulting from thickened interlobular septa. Ill-defined centrilobular nodular pattern may be identically present in HP and respiratory bronchiolitis–associated with interstitial lung disease (RBILD). Sarcoidosis may mimic miliary tuberculosis or haematogenous metastases presenting with miliary pattern, while endobronchial spread of tuberculosis may be indistinguishable from panbronchiolitis, both presenting with tree-in-bud pattern. Atypical infection presenting with ground-glass mimics haemorrhage. Ground-glass pattern with minimal reticulation is seen in desquamative interstitial pneumonia (DIP), RBILD and non-specific interstitial pneumonia (NSIP). Obliterative bronchiolitis and panlobular emphysema may present with decreased attenuation pattern, while obliterative bronchiolitis, chronic pulmonary embolism and HP may manifest with mosaic attenuation pattern. Various mimics in interstitial lung diseases exist. Differential diagnosis is narrowed based on integration of predominant HRCT pattern and clinical history.Teaching Points• To learn about the different HRCT patterns, which are related to interstitial lung diseases.• To be familiar with the more “classical” entities presenting with each HRCT pattern.• To discuss possible overlap of different HRCT patterns and the more common mimics in each case.• To learn about some clues that help differentiate the various diagnostic mimics on HRCT.

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Pulmonary sarcoidosis: the ‘Great Pretender’

Cited by 42 publications

References 48 publications

Multiple huge “cluster” and “galaxy” signs on chest radiography in a patient with pulmonary tuberculosis

Multiple huge “cluster” and “galaxy” signs on chest radiography in a patient with pulmonary tuberculosis

Expiratory CT scan in patients with normal inspiratory CT scan: a finding of obliterative bronchiolitis and other causes of bronchiolar obstruction

Mimics in chest disease: interstitial opacities

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