CTICasesChronic Sarcoidosis with Mycetomas and Cardiac Involvement
Imaging findings
A middle-aged patient with upper-lobe-predominant nodular and fibrotic sarcoidosis (perilymphatic nodules, apical fibrosis) on a 2008 CT progressed by 2015 to fibrocavitary upper lobe disease with a mycetoma, later requiring right upper lobectomy. A 2020 CT shows left upper lobe mycetomas with a surrounding rind of tissue and a positive serum galactomannan, in a steroid-treated, immunocompromised patient. Cardiac MRI shows T2 hyperintensity in the septum and LV apex with septal and RV late gadolinium enhancement, consistent with cardiac sarcoidosis.
Key takeaways
End-stage fibrocavitary sarcoidosis is a substrate for aspergillus colonization producing mycetomas, and a positive galactomannan with a wall of tissue around the cavity may reflect subacute (semi-invasive) aspergillosis, though the cavity-wall thickening can also represent an ABPA-like allergic response to intracavitary aspergillus. The same patient demonstrates cardiac sarcoidosis with the classic mid-myocardial/septal late gadolinium enhancement pattern.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Infected Aortic Endograft with Serratia AortitisInfection
- Diffuse Skin Thickening in Chronic Kidney Disease and DiabetesOther
- Apicoaortic Conduit for Aortic Stenosis with Porcelain AortaArtifact
- Pulmonary Embolism with Westermark SignVascular
- Post-Pneumonectomy Mediastinal Rotation (Buffalo Chest)Artifact
- Adenocarcinoma Developing in EmphysemaNeoplastic
- Angioinvasive MucormycosisInfection
- Peripheral Rhizopus Infection with Necrotic Sequestrum and EmpyemaInfection
See all cases from October 24, 2020 →