CTICasesSarcoidosis with Splenic Infiltration
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Imaging findings
A chest radiograph revealed bilateral bulky hilar lymphadenopathy and fine nodularity. CT confirmed a characteristic pattern of peribronchovascular and subpleural small nodules, along with very symmetrical bilateral hilar lymph nodes (classical stage II sarcoidosis distribution) and subcarinal nodes, none of which were calcified. Abdominal CT demonstrated striking splenomegaly with multiple hyperdense, modular areas consistent with splenic infiltrates.
Key takeaways
Sarcoidosis typically presents with bilateral, symmetrical hilar lymphadenopathy and small perilymphatic nodules. Splenic involvement with infiltrates is a known manifestation, which can mimic lymphoproliferative disorders like lymphoma. However, biopsy showing non-caseating granulomas confirms the diagnosis of sarcoidosis. Ultrasound-guided splenic biopsy is a safe procedure for obtaining tissue diagnosis.
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