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Imaging Manifestations of Abdominal Sarcoidosis

¹ Both authors: Department of Radiology, University of North Carolina School of Medicine, Manning Dr., Old Clinic Bldg., Rm. 2016, Box 7510, Chapel Hill, NC 27599-7510.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A. —29-year-old man with pulmonary sarcoidosis who presented with malaise, anorexia, and abdominal discomfort. Liver biopsy showed noncaseating granulomata consistent with sarcoidosis. (Reprinted with permission from [21]) Contrast-enhanced CT scan shows hepatomegaly with innumerable small hypodense hepatic nodules. Portal adenopathy (arrows) is also present.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B. —29-year-old man with pulmonary sarcoidosis who presented with malaise, anorexia, and abdominal discomfort. Liver biopsy showed noncaseating granulomata consistent with sarcoidosis. (Reprinted with permission from [21]) T2-weighted fat-saturated image (B), T1-weighted fast low-angle shot image (C), and early-phase gadolinium-enhanced T1-weighted fast low-angle shot image (D) depict innumerable hypointense hepatic nodules. Nodules are most clearly seen on T2-weighted and gadolinium-enhanced images. Portal adenopathy (arrows) shows increased signal intensity on T2-weighted image, decreased signal intensity on T1-weighted images, and enhancement on gadolinium-enhanced T1-weighted images.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C. —29-year-old man with pulmonary sarcoidosis who presented with malaise, anorexia, and abdominal discomfort. Liver biopsy showed noncaseating granulomata consistent with sarcoidosis. (Reprinted with permission from [21]) T2-weighted fat-saturated image (B), T1-weighted fast low-angle shot image (C), and early-phase gadolinium-enhanced T1-weighted fast low-angle shot image (D) depict innumerable hypointense hepatic nodules. Nodules are most clearly seen on T2-weighted and gadolinium-enhanced images. Portal adenopathy (arrows) shows increased signal intensity on T2-weighted image, decreased signal intensity on T1-weighted images, and enhancement on gadolinium-enhanced T1-weighted images.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D. —29-year-old man with pulmonary sarcoidosis who presented with malaise, anorexia, and abdominal discomfort. Liver biopsy showed noncaseating granulomata consistent with sarcoidosis. (Reprinted with permission from [21]) T2-weighted fat-saturated image (B), T1-weighted fast low-angle shot image (C), and early-phase gadolinium-enhanced T1-weighted fast low-angle shot image (D) depict innumerable hypointense hepatic nodules. Nodules are most clearly seen on T2-weighted and gadolinium-enhanced images. Portal adenopathy (arrows) shows increased signal intensity on T2-weighted image, decreased signal intensity on T1-weighted images, and enhancement on gadolinium-enhanced T1-weighted images.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A. —64-year-old woman with hepatosplenic sarcoidosis. (Reprinted with permission from [21]) Multiple small hypodense splenic nodules are visible on contrast-enhanced CT scan.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B. —64-year-old woman with hepatosplenic sarcoidosis. (Reprinted with permission from [21]) T2-weighted fat-saturated image shows multiple small hypointense nodules in spleen and less conspicuous lesions in liver. Central periportal high signal intensity (arrows) is seen.

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C. —64-year-old woman with hepatosplenic sarcoidosis. (Reprinted with permission from [21]) Unenhanced T1-weighted image does not show nodules well.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D. —64-year-old woman with hepatosplenic sarcoidosis. (Reprinted with permission from [21]) Splenic nodules are seen as hypoenhancing lesions on early-phase gadolinium-enhanced T1-weighted image.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A. —31-year-old woman with sarcoidosis. (Courtesy of Chong W, Chapel Hill, NC) Contrast-enhanced CT scan shows multiple hypodense hepatic nodules. Portal adenopathy (arrow) is also noted.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B. —31-year-old woman with sarcoidosis. (Courtesy of Chong W, Chapel Hill, NC) Sonogram shows hyperechoic hepatic nodules (arrows). K = kidney.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4. —39-year-old woman with fatigue and elevated alkaline phosphatase level. Sonogram of liver shows diffuse inhomogeneous echotexture with areas of increased echogenicity (arrows) of varying sizes. Liver and cervical lymph node biopsies showed granulomatous inflammation consistent with sarcoidosis. (Courtesy of Mittelstaedt C, Chapel Hill, NC)

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A. —56-year-old woman with jaundice. (Courtesy of Nelson RC, Durham, NC) ERCP image shows high-grade stenosis of extrahepatic biliary tree with prestenotic dilatation.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B. —56-year-old woman with jaundice. (Courtesy of Nelson RC, Durham, NC) Contrast-enhanced CT scans (C obtained 5 mm caudad to B) shows intrahepatic bile duct dilatation with multiple enlarged portal and celiac lymph nodes (arrows). Fine-needle aspiration of porta hepatis nodes revealed noncaseating granulomas consistent with sarcoidosis. Biliary stent is indicated by arrowhead.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C. —56-year-old woman with jaundice. (Courtesy of Nelson RC, Durham, NC) Contrast-enhanced CT scans (C obtained 5 mm caudad to B) shows intrahepatic bile duct dilatation with multiple enlarged portal and celiac lymph nodes (arrows). Fine-needle aspiration of porta hepatis nodes revealed noncaseating granulomas consistent with sarcoidosis. Biliary stent is indicated by arrowhead.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A. —52-year-old woman with leukopenia and mild anemia. (Reprinted with permission from [12]) Contrast-enhanced CT scan shows mild splenomegaly with multiple small hypoattenuating nodules scattered diffusely throughout spleen.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B. —52-year-old woman with leukopenia and mild anemia. (Reprinted with permission from [12]) Sonogram of spleen shows splenomegaly with inhomogeneous echotexture.

View larger version (78K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C. —52-year-old woman with leukopenia and mild anemia. (Reprinted with permission from [12]) Photograph of gross specimen of spleen obtained at splenectomy shows multiple macroscopic nodules separated by thin bands of splenic parenchyma (arrow indicates one of many nodules).

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D. —52-year-old woman with leukopenia and mild anemia. (Reprinted with permission from [12]) Photomicrograph of histopathologic specimen reveals multiple small granulomas (arrows) that have coalesced to form macroscopic nodules (N). (H and E, x10)

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A. —21-year-old woman with fatigue and elevated angiotensin-converting enzyme level. Contrast-enhanced CT scan shows multiple well-defined hypodense nodules scattered throughout spleen. Smaller and less well-defined hepatic nodules are observed, along with portal adenopathy (arrow).

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B. —21-year-old woman with fatigue and elevated angiotensin-converting enzyme level. Photograph obtained at laparoscopy reveals white plaques studding liver, presumably corresponding to sarcoid granulomas.

View larger version (169K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A. —42-year-old woman with sarcoidosis. (Courtesy of Mittelstaedt C, Chapel Hill, NC) T2-weighted fat-saturated image (A) and gadolinium-enhanced T1-weighted image (B) reveal splenomegaly with hypointense and hypoenhancing splenic nodules.

View larger version (164K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B. —42-year-old woman with sarcoidosis. (Courtesy of Mittelstaedt C, Chapel Hill, NC) T2-weighted fat-saturated image (A) and gadolinium-enhanced T1-weighted image (B) reveal splenomegaly with hypointense and hypoenhancing splenic nodules.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C. —42-year-old woman with sarcoidosis. (Courtesy of Mittelstaedt C, Chapel Hill, NC) Sonogram shows splenomegaly with heterogeneous echotexture.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A. —34-year-old woman with sarcoidosis who presented with malaise, anorexia, weight loss, fever, and night sweats. (Reprinted with permission from [21]) Contrast-enhanced axial CT scan shows marked splenomegaly with gastric compression and extensive upper abdominal adenopathy (arrows).

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B. —34-year-old woman with sarcoidosis who presented with malaise, anorexia, weight loss, fever, and night sweats. (Reprinted with permission from [21]) T2-weighted fat-saturated image reveals hyperintense lymphadenopathy (arrows), with suggestion of hypointense speckling.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10. —42-year-old man with uveitis, bilateral hilar adenopathy, and pulmonary interstitial opacities. Sonogram shows enlarged slightly hypoechoic celiac lymphadenopathy (n), liver (L), and celiac axis (arrow). Biopsy of subcutaneous nodule revealed noncaseating granulomata consistent with sarcoidosis. (Courtesy of Mittelstaedt C, Chapel Hill, NC)

View larger version (164K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11. —24-year-old man with epigastric pain and hematemesis. Spot image from upper gastrointestinal examination shows thickened gastric folds. Gastric biopsy revealed noncaseating granulomata consistent with sarcoidosis. (Courtesy of Levy A, Armed Forces Institute of Pathology, Washington, DC)

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A. —36-year-old woman with nausea and vomiting. Radiograph obtained at upper gastrointestinal examination shows irregular gastric ulceration (U) with deformity and narrowing of gastric body and antrum (arrows).

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B. —36-year-old woman with nausea and vomiting. Contrast-enhanced CT scan obtained through upper abdomen shows thickening of gastric antrum and body (arrows) with paraaortic adenopathy (arrowhead).

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12C. —36-year-old woman with nausea and vomiting. Contrast-enhanced CT scan obtained through lower abdomen shows mesenteric adenopathy (arrows) with thickening of cecum and terminal ileum (arrowhead). Because ulcerations proved refractory to therapy, antrectomy and Billroth's I anastomosis were performed along with ileocecal resection and liver biopsy. Histologic examination of pathology specimens showed granulomatous inflammation consistent with sarcoidosis.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13A. —21-year-old woman with nausea, vomiting, and weight loss. Radiograph obtained at upper gastrointestinal examination shows antral narrowing and deformity. Biopsy revealed noncaseating granulomata.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13B. —21-year-old woman with nausea, vomiting, and weight loss. Contrast-enhanced CT scan also shows mild mesenteric and paraaortic adenopathy (arrows).

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14A. —43-year-old man with right lower quadrant pain and weight loss. Compression spot film image obtained during barium enema shows irregular narrowing of cecal lumen. (Reprinted with permission from [54])

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14B. —43-year-old man with right lower quadrant pain and weight loss. Contrast-enhanced CT scan shows circumferentially thickened cecum. (Courtesy of Levy A, Armed Forces Institute of Pathology, Washington, DC)

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14C. —43-year-old man with right lower quadrant pain and weight loss. Abdominal sonogram also shows thickened cecum. At exploratory laparotomy, large cecal mass with extension into small bowel was noted with accompanying adenopathy. Right hemicolectomy was performed. Pathology showed noncaseating granulomatous inflammation involving ileum, colon, and lymph nodes, consistent with sarcoidosis. (Courtesy of Levy A, Armed Forces Institute of Pathology, Washington, DC)

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14D. —43-year-old man with right lower quadrant pain and weight loss. Photomicrograph of histopathologic specimen obtained from cecum shows chronic inflammatory changes in mucosa and noncaseating submucosal granulomas (arrows). (H and E, x10) (Reprinted with permission from [54])

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15. —34-year-old man with bilateral hypoenhancing renal masses (arrows). Fine-needle aspiration of left kidney showed findings compatible with sarcoidosis. (Courtesy of Levy A, Armed Forces Institute of Pathology, Washington, DC)

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 16A. —35-year-old woman with abdominal pain. (Courtesy of Levy A, Armed Forces Institute of Pathology, Washington, DC) Contrast-enhanced CT scan shows heterogeneous mass involving left kidney with paraaortic adenopathy. Patient underwent left nephrectomy.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 16B. —35-year-old woman with abdominal pain. (Courtesy of Levy A, Armed Forces Institute of Pathology, Washington, DC) Photograph of gross specimen shows granulomatous mass. Microscopic pathologic findings were compatible with sarcoidosis.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 17. —44-year-old man with bilateral testicular pain. Testicular sonogram reveals multiple bilateral hypoechoic masses. Excisional biopsy of right testicular mass was performed. Gross pathologic examination (not shown) revealed firm tan mass in wedge of testicular tissue. Microscopic examination (not shown) found confluent epithelioid granulomas compatible with sarcoidosis. (Courtesy of Levy A, Armed Forces Institute of Pathology, Washington, DC)

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 18. —CT scan obtained in 44-year-old man who presented with firm mass in right upper quadrant that corresponded to abnormal right rectus abdominis muscle. Note sarcoid nodule in subcutaneous fat. Biopsy of left internal oblique muscle showed noncaseating granulomas and increased connective tissue and fat consistent with sarcoid myopathy and pseudohypertrophy. (Reprinted with permission from [61])

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