0:00

Here's a patient that has nodules.

0:05

If we look carefully, these are perilymphatic nodules,

0:09

so likes the para bronchovascular structures like the

0:11

subpleural portion of lung.

0:13

Clearly it's mid upper lung preponderant is a beautiful

0:16

example of sarcoidosis.

0:18

But in this patient, this patient started to develop

0:20

some upper lobe para bronchovascular fibrosis.

0:23

There's architectural distortion.

0:25

There's more reticulation that we'd like to see,

0:27

and there's clearly some areas of traction.

0:29

Bronchis as well. These airways should not look like that.

0:32

These are being sort of augmented, right?

0:34

They're being tethered down and the vessels are

0:38

not doing what they should be doing.

0:39

There is this sort of pulling in of some structures, right?

0:44

Like not quite in like a, a common tail configuration,

0:47

but this is highly suggestive of mild sarcoidosis

0:51

or maybe moderate sarcoidosis,

0:53

but with mild superimposed upper lung preponderant

0:55

pulmonary fibrosis.

0:58

These cases of fibrotic sarcoidosis, very common.

1:01

They have this bronchovascular distribution.

1:03

'cause oftentimes the nodules also are hugging the para

1:07

bronchovascular tree.

1:08

So we, we tend to see this.

1:10

Here's the coronal reformation,

1:12

and this is classic fibrotic sarcoidosis,

1:17

but also with some active nodular inflammation.

1:21

And we put into soft tissue and let's look for lymph nodes.

1:23

You always wanna look for lymph nodes, right?

1:24

And so there's another one where there aren't really big

1:26

lymph nodes, and

1:28

so you can get sarcoidosis without lymphadenopathy.

1:31

That's another, another example of that.