Pulmonary sarcoidosis: the 'Great Pretender'

Area of Science:

• Pulmonology
• Radiology
• Pathology

Background:

• Sarcoidosis is a multisystem inflammatory disease of unknown etiology.
• Pulmonary involvement is common, presenting with a wide range of imaging findings.
• Distinguishing sarcoidosis from other interstitial lung diseases can be challenging based on imaging alone.

Purpose of the Study:

• To review and illustrate the spectrum of pulmonary sarcoidosis manifestations on thoracic imaging.
• To focus on atypical imaging features that may mimic other lung diseases.
• To emphasize the importance of considering sarcoidosis in the differential diagnosis of interstitial lung disease.

Main Methods:

• Review of histologically confirmed cases of pulmonary sarcoidosis.
• Illustration of characteristic and atypical findings on high-resolution computed tomography (HRCT) and chest radiography.
• Discussion of imaging features that overlap with other interstitial lung diseases.

Main Results:

• Pulmonary sarcoidosis demonstrates a broad range of appearances on HRCT and chest radiography.
• Atypical manifestations can closely resemble other interstitial lung diseases, posing diagnostic challenges.
• Histological confirmation is essential for accurate diagnosis.

Conclusions:

• Radiologists should consider sarcoidosis in the differential diagnosis of interstitial lung disease, especially when atypical imaging features are present.
• Familiarity with the diverse imaging spectrum of sarcoidosis, including mimics, improves diagnostic accuracy.
• Integrated clinicoradiopathological correlation is key for managing pulmonary sarcoidosis.