HRCT, however, is more accurate in identifying the different manifestations of pulmonary sarcoidosis as well its complications, but we are still searching for an accepted HRCT scoring system. Stage III: infiltrates alone, parenchymal disease only and Stage II: bilateral mediastinal lymphadenopathy (hilar lymphadenopathy) and infiltrates with parenchymal lesion Stage I: bilateral mediastinal lymphadenopathy (hilar lymphadenopathy) Stage 0: normal chest radiographic findings Particularly, there are five radiologic stages (forms) of intrathoracic sarcoidosis on chest radiography as follows: Ī correct staging of pulmonary sarcoidosis based on radiological stage of the disease is necessary to evaluate the sarcoidosis prognosis. Other uncommon possible manifestations are nervous system involvement with lymphocytic meningitis (rare), cranial nerve palsies, hypothalamic/pituitary dysfunction (rare) with diabetes insipidus and myelopathy heart failure from cardiomyopathy (rare) or heart block and sudden death osseous involvement with arthritic syndromes blood abnormalities: anemia, leukopenia, thrombocytopenia and hemolytic anemia with or without splenomegaly (without splenomegaly may reflect bone marrow involvement) gastrointestinal and genitourinary involvement (rare): hepatomegaly, cholestasis, portal hypertension, Crohn’s disease, pancreatic involvement, nephrocalcinosis, vulva itchiness and male infertility (rare) exocrine and endocrine manifestations with hyperprolactinemia, amenorrhea, galactorrhea, or nonpuerperal mastitis in women hypercalciuria and hypercalcemia likely result from the increased 1,25-dihydroxy vitamin D production (rare). Ocular involvement is also possible, which may lead to blindness for untreated anterior or (most frequent) posterior granulomatous uveitis, conjunctival lesions and scleral plaques. Cutaneous involvement may be present not only with erythema nodosum associated with Löfgren syndrome, but also with lupus pernio, violaceous rash on the cheeks or nose (quite common) and maculopapular plaques (quite uncommon). Īnother possible clinical presentation is Löfgren syndrome, which consists in fever, bilateral hilar lymphadenopathy, erythema nodosum (an acute, nodular, cutaneous rash), and arthritis with polyarthralgias and is common in Scandinavian patients, but quite uncommon in African-American and Japanese patients. Pulmonary findings usually are normal but crackles may be audible furthermore in a little part of patients exertional oxygen desaturation may be present. The most common condition (about 50% of cases) is pulmonary complaints with clinical presentation of dyspnea on exertion, cough, chest pain, and rarely hemoptysis. Then, systemic complaints are possible, which manifest itself with fever and anorexia (about 45% of cases). The first state is asymptomatic phase (incidentally detected on chest imaging), approximately in 5% of patients. Signs and symptoms depend on which organs are affected and the presentation varies with the extent and severity of organ involvement. Any organ, however, can be involved by sarcoidosis. Less commonly are involved eyes, liver, heart, and brain, in a percentage ranging between 25 and 50%. The most affected organs by the pathology are the lungs, skin, or lymph nodes (especially intrathoracic lymph nodes). Sarcoidosis is a rare unknown etiology multiorgan granulomatous disease. Imaging gives, moreover, an important contribution to the evaluation of prognosis and follow-up.
Fluoro-deoxy glucose-positron emission tomography (FDG-PET) is another useful tool to assess the extent of disease and has a potential to evaluate the clinical management of patients responding or not to the treatment. Early diagnosis of sarcoidosis can be difficult due to few signs and symptoms in its early stages, and when disease does occur, it may mimic other pathologies, and it is achieved through chest X-ray, computed tomography (CT)-high resolution CT (HRCT), gallium scans. Less commonly eyes, liver, heart, and brain are involved. The areas of the body usually affected by sarcoidosis are lungs, skin, or lymph nodes pulmonary and mediastinal involvement is seen in over 90% of patients. Most commonly, affecting patients between 20 and 40 years old of age, although could be observed at any age (female predominance rare in Asians). Sarcoidosis is a rare unknown etiology multisystem inflammatory disease in which noncaseating granulomas (a collection of inflammatory cells) forms and growth in various organs, involving predominantly lungs, intrathoracic lymph node, skin, and eyes.