CTICasesPulmonary Sarcoidosis Mimicking NSIP
Imaging findings
Chest CT demonstrates bilateral, basal-predominant opacities with dilated airways that mimic non-specific interstitial pneumonia (NSIP) or connective tissue disease-associated ILD. Careful review reveals the opacities are composed of innumerable tiny, coalescent micronodules clustered along bronchovascular bundles rather than true ground-glass opacity, with a slight basal predominance. An earlier CT from six years prior shows the same micronodular pattern in its less confluent form.
Key takeaways
Sarcoidosis with numerous small clustered micronodules can mimic ground-glass opacity on CT, especially when thicker reconstructions are used. The coalescence of tiny perilymphatic nodules can create the appearance of ground-glass opacity or peripheral reticulation mimicking NSIP or CTD-ILD. Careful windowing and thin-section reconstructions are essential to avoid misdiagnosis.
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