CTICasesProgressive Fibrosing Sarcoidosis with Spontaneous Resolution of Mycetoma
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Imaging findings
Serial chest radiographs and CT scans over a 14-year period show progressive bilateral upper lobe volume loss, cicatrization atelectasis, traction bronchiectasis, and large, coalescing masses. Subsequent CT scans demonstrate the formation of chronic upper lobe cavities, one of which contains a mobile intracavitary soft tissue mass consistent with a mycetoma, which is shown to have spontaneously resolved on follow-up imaging.
Key takeaways
Stage IV sarcoidosis is characterized by progressive, irreversible pulmonary fibrosis that frequently displays a strong upper-lung predominance, mimicking the progressive massive fibrosis (PMF) seen in silicosis or coal worker's pneumoconiosis. The resulting architectural distortion and chronic cavitation create an ideal environment for secondary colonization by saprophytic fungi like Aspergillus (mycetoma), which can rarely undergo spontaneous dissolution or resolution without targeted medical or surgical intervention.
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