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Age / Sex : 52 / F
Chief complaint: generalized weakness & weight loss for several months
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)
Courtesy: 이재혁(Yi Jaehyuck), 경북대병원(Kyungpook National University Hospital)
Diagnosis: Sarcoidosis
Discussion
Discussion:
• Inflammatory
disorder of unknown cause that is characterized by noncaseating granulomas
• Most
commonly lungs, lymph nodes, skin, and eyes
• Skeletal
involvement: 1~13% (average 5%)
• Sarcoidal osteopathy
► Hypotheses of bone involvement
- High level of 1,25(OH)2D3: stimulate
osteoclastic activity & bone resorption
-
Granuloma: induce local osteoclastic reaction
-
OAF inducing bone resorption
► Typical
manifestations
-
Lace-like or cyst-like changes within phalanges
-
Lytic lesions with bony erosions: skull, pelvis, and long bones
- Sclerotic lesions: uncommon
• Sarcoidal arthropathy
• Sarcoidal myopathy (4%)
► Nodular type
-
Focal intramuscular masses, often at the musculotendinous junction
-
May be tender, multiple and bilateral
- More
common in lower extremity, superficial portion of the involved muscle
- MRI
▶ bright rim
(granuloma) and central low SI (fibrosis) on T2WI & EnhT1WI
→ "dark star"
appearance
▶Longitudinally
oriented nodules
- USG: central hyperechoic stripes with peripheral hypoechoic stripes
► Myopathic (nonspecific) type
-
Resembles polymyositis
-
Symmetric proximal weakness, elevated serum CK and aldolases, myopathy at EMG
-
MRI: proximal muscle atrophy with fatty replacement (DDx with corticosteroid
myopathy)
References:
1.
Radiologic Manifestations of Sarcoidosis in Various Organs.
Radiographics 2004;24:87-104
2.
Musculoskeletal Sarcoidosis: Spectrum of Appearances at MR
imaging. Radiographics 2003;23:1389-1399
3.
Sonographic Features of Nodular-type Muscular Sarcoidosis. J
Med Ultrasound 2007;15(3):197-201
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