Sarcoidosis is a multi-system disease of unknown etiology characterized by the formation of granulomas in various organs. It affects people of all ethnic backgrounds and occurs at any time of life but is more frequent in African Americans and Scandinavians and in adults between 30 and 50 years of age. Sarcoidosis can affect any organ with a frequency varying according to ethnicity, sex and age. Intrathoracic involvement occurs in 90% of patients with symmetrical bilateral hilar adenopathy and/or diffuse lung micronodules, mainly along the lymphatic structures which are the most affected system. Among extrapulmonary manifestations, skin lesions, uveitis, liver or splenic involvement, peripheral and abdominal lymphadenopathy and peripheral arthritis are the most frequent with a prevalence of 25–50%. Finally, cardiac and neurological manifestations which can be the initial manifestation of sarcoidosis, as can be bilateral parotitis, nasosinusal or laryngeal signs, hypercalcemia and renal dysfunction, affect less than 10% of patients. The diagnosis is not standardized but is based on three major criteria: a compatible clinical and/or radiological presentation, the histological evidence of non-necrotizing granulomatous inflammation in one or more tissues and the exclusion of alternative causes of granulomatous disease. Certain clinical features are considered to be highly specific of the disease (e.g., Lofgren’s syndrome, lupus pernio, Heerfordt’s syndrome) and do not require histological confirmation. New diagnostic guidelines were recently published. Specific clinical criteria have been developed for the diagnosis of cardiac, neurological and ocular sarcoidosis. This article focuses on the clinical presentation and the common differentials that need to be considered when appropriate.

https://www.mdpi.com/2073-4409/10/4/766/pdf

Sarcoidosis: A Clinical Overview from Symptoms to Diagnosis.

Sarcoidosis is a systemic granulomatous disease affecting various organs, and the lungs are the most commonly involved. According to guidelines, diagnosis relies on a consistent clinical picture, histological demonstration of non-caseating granulomas, and exclusion of other diseases with similar histological or clinical picture. Nevertheless, chest imaging plays an important role in both diagnostic assessment, allowing to avoid biopsy in some situations, and prognostic evaluation. Despite the demonstrated lower sensitivity of chest X-ray (CXR) in the evaluation of chest findings compared to high-resolution computed tomography (HRCT), CXR still retains a pivotal role in both diagnostic and prognostic assessment in sarcoidosis. Moreover, despite the huge progress made in the field of radiation dose reduction, chest magnetic resonance (MR), and quantitative imaging, very little research has focused on their application in sarcoidosis. In this review, we aim to describe the latest novelties in diagnostic and prognostic assessment of thoracic sarcoidosis and to identify the fields of research that require investigation.

https://www.mdpi.com/2077-0383/10/11/2222/pdf

Novelties in Imaging of Thoracic Sarcoidosis

Sarcoidosis is a heterogeneous multisystem disease characterized by noncaseating granulomas. We presented 18F-FDG PET/CT findings of sarcoidosis in a previously healthy 43-year-old man who presented intermittent cough after the third dose of COVID-19 vaccination. 18F-FDG PET/CT showed high uptake of one solitary nodule in the right middle lobe, mediastinal lymph nodes, bilateral hila, and multiple nodules under the right pleura, mimicking the malignancy. Nevertheless, the biopsy confirmed distinct noncaseating granulomas. This case emphasizes the onset of sarcoidosis revealed by 18F-FDG PET/CT after COVID-19 vaccination. 

The Onset of Sarcoidosis After COVID-19 Vaccination Revealed by the 18F-FDG PET

Sarcoidosis is a multisystem granulomatous disorder characterized by development of noncaseating granulomas in various organs. Although the etiology of this condition is unclear, environmental and genetic factors may be substantial in its pathogenesis. Clinical features are often nonspecific, and imaging is essential to diagnosis. Abnormalities may be seen on chest radiographs in more than 90% of patients with thoracic sarcoidosis. Symmetric hilar and mediastinal adenopathy and pulmonary micronodules in a perilymphatic distribution are characteristic features of sarcoidosis. Irreversible pulmonary fibrosis may be seen in 25% of patients with the disease. Although sarcoidosis commonly involves the lungs, it can affect virtually any organ in the body. Computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT are useful in the diagnosis of extrapulmonary sarcoidosis, but imaging features may overlap with those of other conditions. Familiarity with the spectrum of multimodality imaging findings of sarcoidosis can help to suggest the diagnosis and guide appropriate management. ©RSNA, 2018.

Sarcoidosis from Head to Toe: What the Radiologist Needs to Know

ABSTRACT
Sarcoidosis is a heterogeneous multisystem disease characterized by noncaseating granulomas. We presented 18F-FDG PET/CT findings of sarcoidosis in a previously healthy 43-year-old man who presented intermittent cough after the third dose of COVID-19 vaccination. 18F-FDG PET/CT showed high uptake of one solitary nodule in the right middle lobe, mediastinal lymph nodes, bilateral hila, and multiple nodules under the right pleura, mimicking the malignancy. Nevertheless, the biopsy confirmed distinct noncaseating granulomas. This case emphasizes the onset of sarcoidosis revealed by 18F-FDG PET/CT after COVID-19 vaccination.

The Onset of Sarcoidosis After COVID-19 Vaccination Revealed by the 18F-FDG PET.

Sarcoidosis, the master mimicker.

Objective: The aim of this study was to determine the incidence of cochlear fibrosis after vestibular schwannoma (VS) resection via middle cranial fossa (MCF) approach. Design: A retrospective case review was conducted. Setting: The review was conducted in a tertiary care academic medical center. Participants: Patients who (1) underwent resection of VS via MCF approach between 2013 and 2018, (2) had complete pre- and post-audiometric testing, and (3) had clinical follow-up with magnetic resonance imaging (MRI) for at least 1 year after surgery were included. Main Outcome Measure(s): The main outcome of this study was cochlear fibrosis as assessed by MRI 1 year after surgery. Results: Fifty-one patients underwent VS resection via MCF technique during the study period. Of 31 patients with AAO-HNS class A or B preoperative hearing ability, 18 (58.0%) maintained class A, B, or C hearing postoperatively. Of 16 patients who lost hearing and had MRI 1 year after surgery, 11 (61.1%) had MRI evidence of fibrosis in at least some portion of the labyrinth and 4 (22.2%) showed evidence of cochlear fibrosis. Of 16 patients with preserved hearing and MRI 1 year after surgery, 4 (25%) had fibrosis in some portion of the labyrinth, with no fibrosis in the cochlea. Conclusions: In patients who lose hearing during VS resection with the MCF approach, there is usually MRI evidence of fibrosis in the labyrinth 1 year after surgery. However, there is also, but less commonly, fibrosis involving the cochlea. It is unclear if this will affect the ability to insert a cochlear implant electrode array.

Austin Jameson

Papers

Sarcoidosis, the master mimicker.

Cochlear Fibrosis after Vestibular Schwannoma Resection via the Middle Cranial Fossa Approach