Sarcoidosis from Head to Toe: What the Radiologist Needs to Know

Abstract

Sarcoidosis is a multisystem granulomatous disorder characterized by development of noncaseating granulomas in various organs. Although the etiology of this condition is unclear, environmental and genetic factors may be substantial in its pathogenesis. Clinical features are often nonspecific, and imaging is essential to diagnosis. Abnormalities may be seen on chest radiographs in more than 90% of patients with thoracic sarcoidosis. Symmetric hilar and mediastinal adenopathy and pulmonary micronodules in a perilymphatic distribution are characteristic features of sarcoidosis. Irreversible pulmonary fibrosis may be seen in 25% of patients with the disease. Although sarcoidosis commonly involves the lungs, it can affect virtually any organ in the body. Computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT are useful in the diagnosis of extrapulmonary sarcoidosis, but imaging features may overlap with those of other conditions. Familiarity with the spectrum of multimodality imaging findings of sarcoidosis can help to suggest the diagnosis and guide appropriate management. RSNA, 2018.

The Burden of Sarcoidosis Symptoms from a Patient Perspective

“…In Denmark, 50% of the cases in a National Patient Registry were apparently asymptomatic [ 1 ]. New imaging tests such as PET scans, revealing occult sarcoidosis localizations and/or multiple organ involvement, have led to changes in reported manifestations [ 5 , 19 ]. In the present study, the reported proportion of organ involvement was comparable between the three countries, except for cardiac and liver involvement (both most prevalent in Germany).…”

Brain miliary enhancement

“…ECD affects multiple organs like long bones, the lungs, the retroperitoneum and the neuroendocrine system [18]. The lungs and the skin are primarily involved in sarcoidosis [14] in combination with pulmonary, mediastinal, cardiac, musculoskeletal and eye involvement [14].…”

“…Sarcoidosis usually presents as a systemic granulomatous disease with lymphadenopathy, pulmonary infiltration, cardiac and musculoskeletal manifestations and lesions in the skin, liver and eye [14]. Young adults aged 25-45 are most commonly affected, and the incidence depends on age and geography, being higher in non-Caucasian ethnicities and women [14]. About 5% of patients with systemic sarcoidosis may show CNS involvement, whereas isolated neurosarcoidosis, i.e.…”

“…strictly confined to the CNS, is rare [15]. Diagnostic work-up for systemic sarcoidosis should include serum angiotensin-converting enzyme and human soluble interleukin-2 receptor/CD25, ophthalmological examination, conjunctival biopsy, chest X-ray or CT scan, hand X-ray, bronchial lavage, bronchoscopy and biopsy and lymph node biopsy [14]. Therapy relies on corticosteroids [14].…”

“…Central nervous system involvement is very variable, with lesions potentially involving the pachymeninges and leptomeninges (seen in up to 40% of cases), pituitary gland and hypothalamus, cranial nerves and brain parenchyma [15,16]. Therefore, headache and cranial nerve palsy are common clinical presentations (30-50% of cases), and the facial nerve is very frequently involved, followed by the optic and the vestibulocochlear nerves [14]. Spinal sarcoidosis is relatively common and can manifest with intramedullary, intraduralextramedullary or extradural lesions; cauda equina syndrome; and arachnoiditis [15].…”