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Large Coalescent Parenchymal Nodules in Pulmonary Sarcoidosis: "Sarcoid Galaxy" Sign

Masashi Nakatsu1,2, Hiroto Hatabu1,2, Kenji Morikawa1, Hidemasa Uematsu2, Yoshiharu Ohno2, Koichi Nishimura3, Sonoko Nagai3, Takateru Izumi3, Junji Konishi1 and Harumi Itoh4

1 Department of Radiology and Nuclear Medicine, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
2 Present address: Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St., Philadelphia, PA 19104.
3 Chest Disease Research Institute, Kyoto University Hospital, Sakyo-ku, Kyoto 606-8507, Japan.
4 Department of Radiology, Fukui Medical University, 23 Shimoaizuki, Matsuoka-cho, Yoshida-gun, Fukui 910-1193, Japan.



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  		Fig. 1A. —23-year-old man with mild cough. Posteroanterior chest radiograph shows mediastinal and hilar lymphadenopathy. Large parenchymal nodules are also seen in both lung fields.

 


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  		Fig. 1B. —23-year-old man with mild cough. CT scan of right upper lobe shows "sarcoid galaxies" that are composed of numerous small granulomas. Fine nodular opacities are seen around large nodules. Small low-attenuation spots are noted in periphery of large nodules (arrows).

 


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  		Fig. 1C. —23-year-old man with mild cough. CT scan of left lung shows another sarcoid galaxy. Small low-attenuation spot is seen in periphery of large nodule (arrow). Distortion of left major fissure is also seen (arrowhead).

 


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  		Fig. 2A. —Asymptomatic 22-year-old man who was found to have radiologic abnormalities by routine examination. Posteroanterior chest radiograph shows mediastinal and hilar lymphadenopathy and large parenchymal nodules in both upper lung fields (arrows).

 


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  		Fig. 2B. —Asymptomatic 22-year-old man who was found to have radiologic abnormalities by routine examination. CT scan of right upper lobe shows large nodule with partially smooth margin (arrows); however, "sarcoid galaxy" appearance is also evident in remaining margin (arrowhead).

 


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  		Fig. 2C. —Asymptomatic 22-year-old man who was found to have radiologic abnormalities by routine examination. CT scan of left upper lobe shows sarcoid galaxies located in periphery.

 


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  		Fig. 3A. —Asymptomatic 23-year-old woman who was found to have radiologic abnormalities by routine examination. Posteroanterior chest radiograph shows mediastinal and hilar lymphadenopathy and large parenchymal nodules in both lung fields. Cavitary nodule is observed in right upper zone.

 


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  		Fig. 3B. —Asymptomatic 23-year-old woman who was found to have radiologic abnormalities by routine examination. CT scan of right upper lobe shows cavitary wall is round and smoothly marginated. "Sarcoid galaxy" sign is also noted.

 


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  		Fig. 4. —Photograph shows globular cluster M92 (NGC 6341), class IV, in Hercules cluster of galaxies. Globular clusters are distributed in spherical halo around galactic center. Stars are more concentrated toward galactic center than in periphery. (Courtesy of Takahashi H, Tokyo, Japan)

 


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  		Fig. 5A. —Pathologic specimens of pulmonary sarcoidosis. Photograph of open lung biopsy specimen shows 11-mm-diameter lesion (arrow). (Distance between marks on ruler indicates 1 mm.)

 


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  		Fig. 5B. —Pathologic specimens of pulmonary sarcoidosis. Photomicrograph of histopathologic specimen shows large sarcoid nodule produced by numerous small granulomas. Peripheral low-attenuation spots on CT correspond to spaces between partially coalescent small nodules (arrow). (H and E, x5)

 


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  		Fig. 6. —Graph shows number of "sarcoid galaxies." Multiple large nodules were seen in 15 patients, whereas solitary nodule was noted in only one patient.

 

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