Abstract
Background
Pulmonary sarcoidosis is a multisystemic granulomatous disease with a broad spectrum
of pulmonary manifestations, ranging from reversible hilar lymphadenopathy and perilymphatic
nodules to irreversible pulmonary fibrosis. The heterogeneity complicates clinical
and radiological differentiation.
Objective
This review presents the typical radiological patterns of pulmonary sarcoidosis, evaluates
diagnostic modalities, and highlights the importance for prognosis and therapy of
distinguishing between reversible and irreversible lesions.
Materials & Methods
A comprehensive literature search focused on recent publications and guidelines, emphasizing
imaging techniques and clinically relevant correlations.
Results
Conventional chest radiography using Scadding criteria provides a simple and cost-effective
method of stage classification, but it also has limitations in terms of accuracy and
in correlation with lung function. Computed tomography (CT) is the most precise imaging
modality, showing characteristic features such as symmetrical hilar and mediastinal
lymphadenopathy, multiple micro- and macronodules with confluent consolidations, and
upper lobe predominance. Advanced stages reveal fibrotic remodeling with linear opacities,
traction bronchiectasis, and prognostically relevant honeycombing. Complications include
pulmonary hypertension, venous compressions, and secondary fungal infections. Magnetic
resonance imaging (MRI) is used primarily for cardiac sarcoidosis detection, while
positron emission tomography (PET) can better assess inflammatory activity and therapy
monitoring. Differential diagnosis with regard to other granulomatous, infectious,
and neoplastic diseases is essential, and it requires an interdisciplinary approach.
Conclusion
Pulmonary sarcoidosis requires a multimodal diagnostic approach, with CT playing a
central role in staging and prognosis. Differentiation between reversible and fibrotic
lesions is critical for therapeutic decisions. Future research should optimize imaging
and integrate clinical, radiological, and functional parameters to improve patient
care.
Key Points
-
Pulmonary sarcoidosis presents a wide spectrum of pulmonary manifestations ranging
from reversible nodules and lymphadenopathy to irreversible fibrotic patterns, with
diagnosis being clinically and radiologically challenging.
-
Computed tomography is the most precise imaging modality for stage classification
and prognosis.
-
Differentiating reversible inflammatory from irreversible fibrotic lesions is crucial
for therapy planning.
-
Differential diagnosis from other granulomatous, infectious, and neoplastic diseases
requires an interdisciplinary approach.
Citation Format
Keywords
sarcoidosis - CT-high resolution - thorax - diagnostic radiology - treatment effects
- fibrosis, cystic
