CTICasesPulmonary Sarcoidosis with Dominant Consolidation
Imaging findings
CT shows a dominant right middle lobe opacity with adjacent smaller nodular opacities suggesting a sarcoid galaxy sign, along with a small number of scattered subcentimeter nodules, many abutting the pleural surfaces and some near bronchovascular bundles. CT-guided biopsy showed lymphoid follicles and non-necrotizing granulomas that were inconclusive, prompting a right middle lobectomy that revealed abundant collagenized sarcoid granulomas.
Key takeaways
Sarcoidosis can present with a dominant mass-like consolidation together with smaller perilymphatic nodules and a galaxy-sign configuration, which can raise concern for a lymphoproliferative disorder. Biopsy showing collagenized non-necrotizing granulomas, with a negative lymphoma workup (including bone marrow), confirms sarcoidosis despite accompanying lymphoid follicles.
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