CTICasesNodular Sarcoidosis with Necrotizing Granulomas and Parotid Involvement
[...]. Nodular Sarcoidosis with Necrotizing Granulomas and Parotid Involvement. CTICases. Published October 8, 2026. https://cticases.com/c/k2s96
Imaging findings
A middle-aged woman had a clear radiograph a few years earlier. New radiographs, including bone-suppressed images, show multiple poorly defined nodules in both lungs. CT shows many ill-defined pulmonary nodules without clear air bronchograms, along with mediastinal and hilar lymphadenopathy. PET shows uptake in both parotid glands, the lung nodules, and the hilar and mediastinal nodes.
Key takeaways
Needle biopsies showed granulomas with substantial, partly centrilobular necrosis. The vasculitis and ANCA workup was negative, cultures and fungal tests were negative, and lymphoproliferative disease was excluded. The working diagnosis is nodular sarcoidosis, which can show some necrosis. The differential includes necrotizing sarcoid granulomatosis, granulomatous infection such as histoplasmosis or coccidioidomycosis, and lymphomatoid granulomatosis. Parotid uptake favors sarcoidosis. Nodular sarcoidosis often looks dramatic on imaging while the patient has only mild symptoms.
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