Sarcoidosis - Stage III

Pathophysiology: See Sarcoidosis Stage I

A progression of the lung disease including the presence of non-caseating granulomata, progressive interstitial lung changes without adenopathy.

CXR/CT Findings:

1. small nodular changes in upper 2/3 of the lung along with increased linear interstitial lines, progressive worsening

2. the nodular changes may be endobronchial, peribronchial or perivsascular giving a beading effect which is seen on high resolution CT.

3. the changes generally have progressed to involve the periphery of the lungs

4. no hilar or mediastinal adenopathy

“Aunt Sophies”: a gamut of mid and upper lung small nodular/interstitial disease without adenopathy:

1. extra thoracic cancers with metastatic lung disease

2. primary lung cancer with metastases

3. lymphoma (nodules usually larger and less in number)

4. granulomatous infection: tuberculosis, fungal infections

5. pulmonary amyloidosis, less common

6. eosinophilic lung disease

7. chronic small airways disease especially with bronchiectasis, and post inflammatory fibrosis

8. rarely, radiation pneumonitis if portal involved upper lungs