CTICasesSarcoidosis Superimposed on Alpha-1 Antitrypsin Deficiency
Imaging findings
High-resolution chest CT shows classic panlobular emphysema with severe lower-lobe-predominant lung destruction and vascular reduction due to alpha-1 antitrypsin deficiency. Superimposed on this, there are diffuse, tiny, symmetric micro-nodules with a perilymphatic and subpleural distribution along the fissures, with biopsy-proven non-necrotizing granulomas in the skin.
Key takeaways
Sarcoidosis and alpha-1 antitrypsin deficiency can coexist. The typical perilymphatic and subpleural nodular pattern of pulmonary sarcoidosis remains identifiable even in regions of severe panlobular emphysema, though the nodules may appear more subtle or mimic ground-glass opacities.
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