Intravascular sarcoidosis presenting as pulmonary vein occlusion: CT and pathologic findings

It is well known that destruction of the distal capillary bed from extensive fibrosis and honeycombing in the setting of sarcoidosis may lead to pulmonary hypertension. However, we report an unusual manifestation of sarcoidosis where pulmonary hypertension resulted from granulomatous involvement of the pulmonary veins and venules. This presented as venous occlusion and intraluminal filling defects that simulated thrombus on chest computed tomography. To our knowledge, this is the first reported imaging case of such a presentation.