CTICasesAlveolar Sarcoidosis
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Imaging findings
Chest radiograph shows bilateral hilar, paratracheal, and left subaortic lymphadenopathy, with faint opacities in the lower lung zones. High-resolution chest CT reveals extensive, symmetric hilar and mediastinal lymph node enlargement, along with large, consolidative, mass-like opacities in the middle and lower lobes containing patent, air-filled bronchi. Histopathology from a lung biopsy demonstrates highly coalescent, non-caseating granulomas tracking along the lymphatics and bronchi, confirming sarcoidosis.
Key takeaways
Alveolar sarcoidosis, also known as nodular or consolidative sarcoidosis, is an atypical manifestation where extensive, localized clusters of non-caseating granulomas coalesce to form mass-like areas of parenchymal consolidation that can mimic pneumonia, lymphoma, or adenocarcinoma. Despite the name, the process remains fundamentally interstitial and lymphatic-centric, but the sheer density of granulomas fills the alveolar spaces, often presenting with air bronchograms on imaging.
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