La radiologia medica

, Volume 123, Issue 3, pp 174–184 | Cite as

Atypical HRCT manifestations of pulmonary sarcoidosis

  • Diletta Cozzi
  • Elena Bargagli
  • Alessandro Giuseppe Calabrò
  • Elena Torricelli
  • Federico Giannelli
  • Edoardo Cavigli
  • Vittorio Miele



To present our experience of cases of pulmonary sarcoidosis with atypical HRCT patterns found during 2016 focusing on the differential diagnosis to contribute to the difficult role of the radiologist in the disease identification and to help the clinicians to reach the diagnosis.

Materials and methods

The HRCT examinations of 47 patients with sarcoidosis were studied retrospectively. All patients had a histopathological confirm of the disease. 29 (61.7%) show a typical pulmonary pattern and 18 (38.3%) an atypical pattern. The latter were evaluated by three experienced radiologists dedicated to thoracic disease to radiologically define the predominant pattern of presentation.


In the 18 patients (38.3%) with atypical sarcoidosis, the following parenchymal patterns were observed: four patients (22.2%) had interstitial fibrotic alterations, three patients (16.6%) with reticular pattern with inter–intralobular septal thickening, two patients (11.1%) with small-airway involvement with mosaic oligoemia, two patients (11.1%) with pleural involvement (pneumothorax and pleural plaques), one patient (5.5%) with fibrocystic changes, 1 (5.5%) with halo-sign, 1 (5.5%) with diffuse bilateral ground-glass opacities, and 1 (5.5%) with isolated lung mass; in addition, three patients (16.6%) with atypical lymph node pattern were also found.

Conclusions and Discussion

The atypical pulmonary alterations found in CT examination can be confused with other lung diseases and they are always a challenge even for the most experienced radiologist. In our experience, cases with atypical pulmonary sarcoidosis patterns evaluated in the study are consistent with similar cases described in the literature, both in lymph node and atypical parenchymal involvement. All the atypical characteristics of the work should alert the radiologist to consider sarcoidosis among the possible differential diagnoses, always correlating the results of the computed tomography examination with appropriate clinical-laboratory evaluations.


Sarcoidosis High-resolution computed tomography Diagnosis Atypical manifestations Differential diagnosis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest related to the publication of this article.

Ethical approval

All procedures performed in studies involvement human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Italian Society of Medical Radiology 2017

Authors and Affiliations

  1. 1.Department of RadiologyCareggi University HospitalFlorenceItaly
  2. 2.Section of Respiratory Medicine, Department of Clinical and Experimental Biomedical SciencesAOUCFlorenceItaly

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