0:00

Another classic example of sarcoidosis.

0:03

This patient's been biopsied, as you can tell,

0:04

there's suture material within the right upper lobe.

0:07

We see nice examples of para bronchovascular

0:11

nodularity within the upper lobes.

0:14

And so we would invoke something called the galaxy sign.

0:17

I don't know if you guys have heard of that,

0:18

the galaxy sign in the setting of many of these nodules.

0:22

Here's a classic example here, right?

0:25

So it's when you see this central nodule

0:28

with these little tentacles of reticulate, nodularity

0:33

almost look like a studded nodule there.

0:36

And so that, especially when it's para bronchovascular,

0:38

like this, highly suggestive of a ulous process.

0:42

And so the classic ulous process to do this is sarcoidosis.

0:46

And so then if we scroll through the rest of the CT scan,

0:48

we're gonna see that there's a basal gradient

0:52

or probably an upper lung gradient

0:54

where the lung bases are relatively spared.

0:56

There's still some nodules there,

0:57

but the majority of these nodules,

0:59

which again are paralympic, right, likes the fissures,

1:01

likes the sub lung, likes the bronchovascular tree, likes

1:05

to inter life their septa here

1:06

and has this sort of clustering area

1:08

where some nodules are closer together, some portion

1:10

of lungs are almost completely spared.

1:13

So classic for perilymphatic, nodularity, all that together

1:16

with the upper lung preponderance points straight

1:20

to a diagnosis of sarcoidosis.

1:22

Some people I think are confu get confused

1:24

and say, oh, well you need

1:25

to have associated lymphadenopathy.

1:28

Remember, you don't need to necessarily need

1:29

to see lymphadenopathy in someone

1:31

who has pulmonary sarcoidosis, right?

1:33

So the sarcoidosis can do what sarcoidosis wants,

1:37

and sometimes there are essentially no lymph nodes at all,

1:40

like in this case.