CTICasesSarcoidosis — Subcarinal and Bilateral Hilar Lymphadenopathy with Upper Lobe Micro-Nodules
Imaging findings
Chest radiograph demonstrates a lumpy-bumpy left hilar contour, subtle widening of the aortopulmonary window and right paratracheal stripe, and obliteration of the normal subcarinal window on the lateral view. CT confirms bulky subcarinal and bilateral hilar lymphadenopathy with heterogeneous nodes and bilateral upper lobe micro-nodules in a perilymphatic distribution.
Key takeaways
Sarcoidosis classically produces bilateral hilar and right paratracheal lymphadenopathy (the 1-2-3 sign or Pawnbroker sign) along with upper lobe perilymphatic micro-nodules. On the lateral radiograph, the subcarinal (inferior hilar) window normally contains pulmonary veins but becomes opacified with subcarinal lymphadenopathy. Comparison to a prior radiograph is invaluable for detecting the subtle hilar contour change.
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