Pulmonary Sarcoidosis: Spectrum of imaging findings

Irini Blana, Demosthenes D Cokkinos, Maria Skilakaki


Sarcoidosis is a systemic chronic inflammatory disorder of unknown aetiology, characterised by non-caseating epithelioid cell granulomas. A diagnosis of the disease requires compatible clinical and imaging findings, supported by the identification of typical lesions in at least one organ system, and the exclusion of other causes of granulomatous diseases. It has a wide spectrum of clinical and radiological manifestations; however the lung as well as mediastinal and hilar lymph nodes are involved in more than 90% of cases. For the evaluation of pulmonary sarcoidosis conventional chest radiograph remains the first imaging modality of choice and may often be sufficient to establish the diagnosis. However, the protean radiological appearance of the disorder, its ability to mimic other lung diseases as well as its complications, have rendered the use of chest CT crucial in several clinical settings. In this review we discuss the variety of chest radiography and CT findings in pulmonary sarcoidosis, typical and atypical, involving the lung parenchyma, the mediastinum, small and large airways and the pleura.


sarcoidosis; lung; chest radiography; computed tomography; differential diagnosis

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Valeyre D, Bernaudin J-F, Florence J, et al. Pulmonary sarcoidosis. Clin Chest Med 2015; 36(4): 631-641.

Valeyre D, Prasse A, Nunes H, et al. Sarcoidosis. Lancet 2014; 383(9923): 1155-1167.

Hamzeh N. Sarcoidosis. Med Clin N Am 2011; 95(6): 1223-1234.

Statement on sarcoidosis. Joint statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ESR Executive Committee, February 1999. Am J Respir Crit Care Med 1999; 160(2): 736-755.

Criado E, Sanchez M, Ramirez J, et al. Pulmonary Sarcoidosis: Typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics 2010; 30(6): 1567-1586.

Fraser R, Muller N, Colman N, et al. Sarcoidosis. In: Bralow L (ed). Diagnosis of diseases of the CHEST. Fourth Edition. Philadelphia, Pennsylvania, United States of America. W.B.Saunders Company 1999, pp 1542-1563.

Shadid S, ter Maaten JC. Sarcoidosis-a great mimicker. J Intern Med 2002; 251(2): 174-176.

Little B. Sarcoidosis: Overview of pulmonary manifestations and imaging. Semin Roentgenol 2015; 50(1): 52-64.

Baughman R, Lower E, Gibson K. Pulmonary manifestations of sarcoidosis. Presse Med 2012; 41(6 Pt 2): e289-302.

Nishino M, Lee K, Itoh H, et al. The spectrum of pulmonary sarcoidosis: Variations of high-resolution CT findings and clues for specific diagnosis. Eur J Radiol 2010; 73(1): 66-73.

Nunes H, Uzunhan Y, Gille T, et al. Imaging of sarcoidosis of the airways and lung parenchyma and correlation with lung function. Eur Respir J 2012; 40(3): 750-765.

Akbar J, Meyer C, Shipley R, et al. Cardiopulmonary imaging in sarcoidosis. Clin Chest Med 2008; 29(3): 429-443.

Keijsers R, Veltkamp M, Grutters J. Chest imaging. Clin Chest Med 2015; 36(4): 603-619.

Silva M, Nunes H, Valeyre D, et al. Imaging of sarcoidosis. Clin Rev Allerg Immunol 2015; 49(1): 45-53.

Vagal A, Shipley R, Meyer C. Radiological manifestations of sarcoidosis. Clin Dermatol 2007; 25(3): 312-25.

Mihailovic-Vucinic V, Jovanovic D. Pulmonary sarcoidosis. Clin Chest Med 2008; 29(3): 459-473.

Spagnolo P, Sverzellati N, Wells A, et al. Imaging aspects of the diagnosis of sarcoidosis. Eur Radiol 2014; 24(4): 807-816.

Hoang D, Nguyen E. Sarcoidosis. Semin Roentgenol 2010; 45(1): 36-42.

Hawtin K, Roddie M, Mauri F, et al. Pulmonary sarcoidosis: the ‘Great Pretender’. Clin Radiol 2010; 65(8): 642-650.

Shroff G, Guirguis M, Ocazionez D, et al. Beyond metastatic disease: A pictorial review of multinodular lung disease with computed tomographic pathologic correlation. Can Assoc Radiol J 2015; 66(1): 16-23.

Ors F, Gumus S, Aydogan M, et al. HRCT findings of pulmonary sarcoidosis: relation to pulmonary function tests. Multidiscip Respir Med 2013; 8(1): 8.

Jain V, Hasselquist S, Delaney M. PET scanning in sarcoidosis. Ann.NY. Acad.Sci 2011; 1228: 46-58.

Shahzad H, Ur-Rehman S, Fatima K, et al. Case series and literature review of multiple nodular sarcoidosis. BMC Res Notes 2013; 6: 394.

Patterson K, Strek M. Pulmonary fibrosis in sarcoidosis. Clinical features and outcomes. Ann Am Thorac Soc 2013; 10(4): 362-370.

Jeong Y, Lee K, Chung M, et al. Chronic hypersensitivity pneumonitis and pulmonary sarcoidosis: Differentiation from usual interstitial pneumonia using high-resolution computed tomography. Semin Ultrasound CT MR 2014; 35(1): 47-58.

Kouranos V, Jacob J, Wells A. Severe sarcoidosis. Clin Chest Med 2015; 36(4): 715-726.

Morgenthau A, Teirstein A. Sarcoidosis of the upper and lower airways. Expert Rev Respir Med 2011; 5(6): 823-833.

Judson M. The Diagnosis of sarcoidosis. Clin Chest Med 2008; 29(3): 415-427.

Trail Z, Maskell G, Gleeson F. High-resolution CT findings of pulmonary sarcoidosis. AJR Am J Roentgenol 1997; 168(6): 1557-1560.

Hansell D, Milne D, Wilsher M, et al. Pulmonary sarcoidosis: morphologic associations of airflow obstruction at thin-section CT. Radiology 1998; 209(3): 697-704.

Magkanas E, Voloudaki A, Bouros D, et al. Pulmonary sarcoidosis. Correlation of expiratory high-resolution CT findings with inspiratory patterns and pulmonary function tests. Acta Radiol 2001; 42(5): 494-501.

Akira M, Kozuka T, Inoue Y. Long-term follow-up CT scan evaluation in patients with pulmonary sarcoidosis. Chest 2005; 127: 185-191.

Crystal RG, Roberts WC, Hunninghake GW, et al. Pulmonary sarcoidosis: a disease characterized and perpetuated by activated lung T-lymphocytes. Ann Intern Med 1981; 94: 73–94.

Nishimura K, Itoh H, Kitaichi M, et al. Pulmonary sarcoidosis: correlation of CT and histopathologic findings. Radiology 1993; 189: 105–109.

Murdoch J, Muller NL. Pulmonary sarcoidosis: changes on follow-up CT examination. AJR Am J Roentgenol 1992; 159: 473–477.

Saito W, Kobayashi H, Shinkai M, et al. Pulmonary involvement in sarcoidosis: CT findings at diagnosis and their changes at follow-up in cases without corticosteroid treatment. Nihon Kokyuki Gakkai Zasshi 2002; 40: 210–214.

Abehsera M, Valeyre D, Grenier P, et al. Sarcoidosis with pulmonary fibrosis: CT patterns and correlation with pulmonary function. AJR Am J Roentgenol 2000; 174: 1751–1757.

Schuster D, Alazraki N. Gallium and other agents in diseases of the lung. Semin Nucl Med 2002; 32(3): 193-211.

Alavi A, Buchpiguel C, Loessner A. Is there a role for FDG PET imaging in the management of patients with sarcoidosis? J Nucl Med 1994; 35(10): 1650-1652.

Larson S. Cancer or Inflammation? A holy grail for nuclear medicine. J Nucl Med 1994; 35(10): 1653-1655.

Hubner K, Buonocore E, Gould H, et al. Differentiating benign from malignant lung lesions using “Quantitative” FDG PET images. Clin Nucl Med 1996; 21(12): 983-984.

Xiu Y, Yu J, Cheng E, et al. Sarcoidosis demonstrated by FDG PET imaging with negative findings on gallium scintigraphy. Clin Nucl Med 2005; 30(3): 193-195.

Kazuo K, Masatoshi I, Kaoru O, et al. Advantage of delayed whole-body FDG-PET imaging for tumour detection. EurJ Nucl Med 2001; 28(6): 696-703.

Ludwig V, Fordice S, Lamar R, et al. Unsuspected skeletal sarcoidosis mimicking metastatic disease on FDG positron emission tomography and bone scintigraphy. Clin Nucl Med 2003; 28(3): 176-179.

Sobic-Saranovic D, Artiko V, Obradovic V. FDG PET imaging in sarcoidosis. Semin Nucl Med 2013; 43(6): 404-411.


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