Clinicoradiological Sarcoidosis: A Case Study Of Extensive Mediastinal And Abdominal Nodal Calcifications With Pulmonary Nodularity

Abstract

Aim: To present a rare case of sarcoidosis with extensive calcifications in mediastinal and abdominal lymph nodes, accompanied by perilymphatic pulmonary nodules, emphasizing the diagnostic value of radiological imaging in such atypical presentations. Introduction: Sarcoidosis is a multisystem granulomatous disorder of unknown cause, predominantly affecting the lungs and lymphatic system. While typical imaging findings can guide diagnosis, atypical radiological features require careful evaluation to differentiate from malignancy or other conditions. Materials and Methods: A 58-year-old female reported persistent cough and breathlessness. High-resolution computed tomography (HRCT) of the chest and contrast-enhanced CT (CECT) of the abdomen were performed. Imaging revealed multiple calcified lymph nodes across mediastinal and abdominal compartments. Pulmonary nodules were observed along peribronchovascular and subpleural regions, predominantly in a perilymphatic distribution. Additional findings included the nodular interface sign and axial interstitial thickening. Whole-body PET-CT and clinical investigations were undertaken to rule out malignancy. Results: Radiological evaluation showed extensive lymph node calcifications in the paraesophageal, pretracheal, paratracheal, subcarinal, and prevascular regions of the mediastinum, as well as abdominal nodes including celiac, peripancreatic, porta hepatis, precaval, and paraaortic areas. Lung imaging demonstrated peribronchovascular thickening, subpleural nodules, and nodular interfaces—hallmark features suggestive of sarcoidosis. PET-CT findings further supported a benign, inflammatory etiology. The diagnosis of sarcoidosis was established through clinicoradiological correlation. Conclusion: This case underscores the critical role of imaging in diagnosing atypical sarcoidosis. The presence of widespread nodal calcification and classic perilymphatic pulmonary nodules should prompt consideration of sarcoidosis, particularly when malignancy is excluded. Radiological assessment, combined with clinical evaluation, is vital for accurate diagnosis and appropriate management of unusual presentations of sarcoidosis.