CTICasesSarcoidosis Progressing from Stage I to Stage III
Imaging findings
Initial presentation in 2016 shows a classic stage I sarcoidosis pattern on chest radiograph: bilateral symmetric hilar and mediastinal lymphadenopathy without significant parenchymal lung disease. Corresponding CT confirms large potato-shaped bilateral hilar and mediastinal nodes with only a few scattered lung nodules. Follow-up approximately one year later shows partial resolution of lymphadenopathy with new development of extensive perilymphatic micronodules throughout both lungs on both radiograph and CT, representing progression to stage III. The CT demonstrates classic bilateral perilymphatic nodules in a peribronchovascular and fissural distribution with the lymphadenopathy partially resolved, indicating apparent improvement masking true disease progression.
Key takeaways
Sarcoidosis can evolve paradoxically from stage I (hilar adenopathy alone) to stage III (parenchymal disease without adenopathy) or the combined stage II, with the apparent improvement of lymphadenopathy masking progression of lung involvement. This case was initially misdiagnosed as lymphoma at the outside institution. When bilateral hilar adenopathy begins to resolve and new parenchymal micronodules appear in a perilymphatic distribution, this pattern represents stage I-to-III progression rather than treatment success. Sarcoidosis-related air trapping from airway compression by nodes can coexist and be detected on expiratory imaging.
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