Imaging of Biliary Involvement in Sarcoidosis: Computed Tomography, Magnetic Resonance Cholangiopancreatography, and Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid-Enhanced Magnetic Resonance Imaging Findings

Abstract

Sarcoidosis is a multisystem disease usually affecting the chest, hilar lymph nodes, and lungs, but can potentially involve any organ; therefore, its clinical presentation may vary. Hepatobiliary involvement is rare, and typically asymptomatic; however, it can lead to cirrhosis, and may require liver transplantation. In this report, we present a rare case of a patient affected by sarcoidosis with hepatobiliary involvement. He presented to our hospital complaining of dyspnea triggered by moderate efforts and oppressive thoracic discomfort. Chest X-ray showed multiple bilateral nodular opacities and enlargement of both hilar regions, confirmed by a subsequent total-body computed tomography scan and positron emission tomography, which also revealed cardiac, splenic, and hepatic involvement. Liver function was studied via gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging, and magnetic resonance cholangiopancreatography (MRCP) was also performed. The diagnosis of sarcoidosis was finally achieved via liver biopsy, revealing non-necrotizing granulomas in the periportal space. The patient was treated with prednisone per os, with regression of all lesions at all levels. Although other cases of biliary sarcoidosis have been described, this report provides a complete image set of Gd-EOB-DTPA-enhanced magnetic resonance and MRCP images that is lacking in the English literature, and which may be useful for diagnosis.

Hepatic Sarcoidosis: Lesson Based on a Case Report

“…[ 3 ] Rare associations are also described with skin, lacrimal, and ocular gland manifestations as well as with rare syndromes such as Löfgren’s[ 4 ] or Heerfordt’s. [ 5 ] The disease can involve in minimal percentages of various other abdominal parts such as the intra- and extra-hepatic biliary tract with cholestatic jaundice;[ 6 ] even more rarely, the disease can affect the pancreas with episodes of nonspecific pancreatitis, the stomach with ulcer-like lesions or thickening of the mucous membrane, and the urinary tract with interstitial nephritis or with hydronephrosis from extrinsic compression caused by the lymph nodes. An association between hepatic sarcoidosis and Crohn’s disease has also been described in the literature[ 7 ] which, although rare, further suggests the autoimmune origin of sarcoidosis.…”