【Case Sharing】Atypical sarcoidosis

【Case Introduction】

The patient, female, 50 years old, was admitted to the hospital with shoulder pain, joint pain at the time of admission, cough, swollen lymph nodes in the neck, low-grade fever

Routine post-hospital check-up:

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Concentrate:

Picture of enlarged hilar lymph nodes on both sides and enlarged right upper mediastinal lymph nodes (↑ indicated site)

Fig.

Figures 3 and 4 Enhancement examination lesions showed obvious uneven strengthening

Figures 5 and 6 proliferative lymphocytes and a small number of epithelioid cells

【Discussion】

The clinical manifestations of sarcoidosis lack specificity, and the imaging manifestations are diverse, insidious, and atypical, so it is necessary to pay attention

In most cases, CT imaging shows enlargement and proliferation

Because it is clinically distinguished from lymphoma, lung cancer, tuberculosis, and chest metastases:

(1) Lymphoma tends to occur in multiple groups of lymph nodes in the anterior mediastinum, and it is mostly fused into clumps, which enhances and strengthens the manifestations

(2) Lung cancer: typical chest imaging manifestations (lobar mass, obstructive changes, glitch nodules), dry cough, hematosus, cachexia and sputum detection of cancer cells, metastases found in other parts, elevated neurogenolase can be the most adjunctive method for lung cancer diagnosis, but it is not a method of diagnosis[2].

(3) Tuberculosis is also manifested by lymphadenopathy and central caseous necrosis of the lymph nodes, which is strengthened peripherally and not strengthened in the center when CT is strengthened

(4) Thoracic metastases, often with a history of primary tumor, typical chest imaging manifestations (double lower lung field and pulmonary field with subpleural nodules, pulmonary hilar radial arrangement of cord strip shadows, pleural nodules, pleural effusion) anterior trachea-vena cava and aortic artery window lymph nodes are obvious, different sizes, and fusion also occurs[3].

In the process of diagnosing sarcoidosis, we cannot rely solely on CT imaging results, because some diseases are similar in image performance, so we must also pay attention to the analysis of clinical symptoms and signs, laboratory tests, pathological examinations and diagnostic treatment (hormone therapy) for differential diagnosis, reduce the misleading clinical work of imaging diagnostic errors, and strive for early diagnosis and early treatment