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Lee S, Lee IS, Mok J, Song YS, Choi KU. Muscular sarcoidosis involving the chest and abdominal walls: case report with MR imaging. Skeletal Radiol 2018; 47:407-411. [PMID: 29038921 DOI: 10.1007/s00256-017-2787-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/21/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
Sarcoidosis is an inflammatory disorder that is characterized by the presence of noncaseating granulomas in tissues, involving many organs and tissues. Extra-pulmonary, especially muscular sarcoidosis is a rare condition. The most common location of the muscular sarcoidosis is known to be the proximal muscles of the extremities; however, there have been no cases of diffuse involvement of the chest and abdominal wall muscles. Here, we report a rare muscular sarcoidosis with infiltrative pattern in the chest and abdominal wall muscles and describe the MR imaging findings that were mistaken as lymphoma at initial diagnosis. Although our case did not show characteristic MR findings of muscular sarcoidosis, clinicians or radiologists who are aware of these imaging features can perform early systemic survey for sarcoidosis. Also muscle biopsy is very important to confirm the sarcoidosis and distinguish it from other tumors.
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Affiliation(s)
- Seunghyun Lee
- Department of Radiology, Pusan National University Hospital, Biomedical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, South Korea.,Pusan National University School of Medicine, Busan, South Korea
| | - In Sook Lee
- Department of Radiology, Pusan National University Hospital, Biomedical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, South Korea. .,Pusan National University School of Medicine, Busan, South Korea.
| | - Jeongha Mok
- Department of Internal Medicine, Pusan National University Hospital, Biomedical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, South Korea
| | - You Seon Song
- Department of Radiology, Pusan National University Hospital, Biomedical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, South Korea.,Pusan National University School of Medicine, Busan, South Korea
| | - Kyung-Un Choi
- Department of Pathology, Pusan National University Hospital, Biomedical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, South Korea
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Smitaman E, Flores DV, Mejía Gómez C, Pathria MN. MR Imaging of Atraumatic Muscle Disorders. Radiographics 2018; 38:500-522. [PMID: 29451848 DOI: 10.1148/rg.2017170112] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Atraumatic disorders of skeletal muscles include congenital variants; inherited myopathies; acquired inflammatory, infectious, or ischemic disorders; neoplastic diseases; and conditions leading to muscle atrophy. These have overlapping appearances at magnetic resonance (MR) imaging and are challenging for the radiologist to differentiate. The authors organize muscle disorders into four MR imaging patterns: (a) abnormal anatomy with normal signal intensity, (b) edema/inflammation, (c) mass, and (d) atrophy, highlighting each of their key clinical and imaging findings. Anatomic muscle variants, while common, do not produce signal intensity alterations and therefore are easily overlooked. Muscle edema is the most common pattern but is nonspecific, with a broad differential diagnosis. Autoimmune, paraneoplastic, and drug-induced myositis tend to be symmetric, whereas infection, radiation-induced injury, and myonecrosis are focal asymmetric processes. Architectural distortion in the setting of muscle edema suggests one of these latter processes. Intramuscular masses include primary neoplasms, metastases, and several benign masslike lesions that simulate malignancy. Some lesions, such as lipomas, low-flow vascular malformations, fibromatoses, and subacute hematomas, are distinctive, but many intramuscular masses ultimately require a biopsy for definitive diagnosis. Atrophy is the irreversible end result of any muscle disease of sufficient severity and is the dominant finding in disorders such as the muscular dystrophies, denervation myopathy, and sarcopenia. This imaging-based classification, in correlation with clinical and laboratory data, will aid the radiologist in interpreting MR imaging findings in patients with atraumatic muscle disorders. ©RSNA, 2018.
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Affiliation(s)
- Edward Smitaman
- From the Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.); Department of Radiology, Philippine Orthopedic Center, Quezon City, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); and Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.)
| | - Dyan V Flores
- From the Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.); Department of Radiology, Philippine Orthopedic Center, Quezon City, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); and Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.)
| | - Catalina Mejía Gómez
- From the Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.); Department of Radiology, Philippine Orthopedic Center, Quezon City, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); and Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.)
| | - Mini N Pathria
- From the Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.); Department of Radiology, Philippine Orthopedic Center, Quezon City, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); and Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.)
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Sudo M, Wada Y, Narita I, Mba B, Houchens N. A Strong Diagnosis of Weakness. J Hosp Med 2017; 12:989-993. [PMID: 29236098 DOI: 10.12788/jhm.2858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Masanori Sudo
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoko Wada
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Benjamin Mba
- Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA
- Rush University Medical Center, Chicago, Illinois, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Tsujimoto N, Saraya T, Shimoda M, Goto H. Three stripes sign: muscle involvement with internal fibrosis in a patient with sarcoidosis. BMJ Case Rep 2014; 2014:bcr-2014-204691. [PMID: 24916984 DOI: 10.1136/bcr-2014-204691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University, Mitaka, Japan
| | | | - Hajime Goto
- Department of Respiratory Medicine, Kyorin University, Mitaka, Japan
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Nemoto I, Shimizu T, Fujita Y, Tateishi Y, Tsuji-Abe Y, Shimizu H. Tumour-like muscular sarcoidosis. Clin Exp Dermatol 2007; 32:298-300. [PMID: 17397354 DOI: 10.1111/j.1365-2230.2007.02371.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown aetiology with variable manifestations, which may affect virtually any organ. Muscular sarcoidosis is a rare entity, and among this group of muscular lesions, the tumour-like muscular sarcoidosis subtype is extremely rare. We report on two sarcoidosis cases that presented muscular sarcoid lesions with subcutaneous tumours.
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Affiliation(s)
- I Nemoto
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
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Chen HH, Hsieh TY, Chen DY, Lan HHC, Hsieh CW. Sonographic Features of Nodular-type Muscular Sarcoidosis. J Med Ultrasound 2007. [DOI: 10.1016/s0929-6441(08)60037-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
The origins of neurosarcoidosis, a multisystemic granulomatous disease, remain unknown. Nervous system localizations remain rare, but severe. Lymphocytic meningitis, psychiatric disorders, diabetes insipidus and cranial nerve palsy are the most frequent signs. Cerebral fluid test and cervical medullar and cerebral MRI with gadolinium have to be performed first. In some cases, histological evidence of granuloma have to be obtained with neuromuscular, meningeal or cerebral biopsies. Functional impairment and life-threatening conditions require early corticosteroid therapy. In worsening cases or in the event of no therapeutic response or poor tolerance to corticosteroids, other immunosuppressive agents should be associated. Maintenance therapy and most often life long maintenance therapy allow a continuous success while avoiding relapse.
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Tohme-Noun C, Le Breton C, Sobotka A, Boumenir ZE, Milleron B, Carette MF, Khalil A. Imaging Findings in Three Cases of the Nodular Type of Muscular Sarcoidosis. AJR Am J Roentgenol 2004; 183:995-9. [PMID: 15385292 DOI: 10.2214/ajr.183.4.1830995] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Sarcoidosis is a granulomatous multisystem disorder that may uncommonly involve muscle. We report the sonographic and MRI findings in three cases of the nodular type of muscular sarcoidosis. CONCLUSION Intramuscular hypoechoic well-defined nodules in young patients or patients with a history of sarcoidosis suggest the diagnosis of intramuscular sarcoid. MRI is useful in detecting muscle sarcoid, evaluating the extent and distribution of muscle involvement, and monitoring the patient during follow-up after steroid therapy. MRI showed nodules that were iso- or hyperintense relative to muscle on T1-weighted sequences. On T2-weighted images and STIR sequences, we observed numerous intramuscular nodules of homogeneous high signal intensity. All nodules enhanced homogeneously on contrast-enhanced T1-weighted sequences. Disappearance of all nodules was seen on follow-up sonograms and MR images after patients had received steroid therapy.
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Affiliation(s)
- C Tohme-Noun
- Department of Radiology, Hôpital Tenon, 4 Rue de la Chine, Paris 75970, Cedex 20, France
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Abstract
MRI has become of great importance in the study of several aspects of sarcoidosis. The main development has taken place in the assessment of neurosarcoidosis, but MRI may be also useful in the evaluation of sarcoidosis of the bone, muscle, heart, and intrathoracic. Nuclear imaging in sarcoidosis acquired a great expansion with the introduction of (67)gallium scanning as a marker of activity. Although its current use has decreased, it is still very helpful in particular situations of the disease. Other more recently introduced nuclear imaging techniques may have a role in the evaluation of cardiac sarcoidosis and in the assessment of the extension of the disease.
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Affiliation(s)
- Juan Mañá
- University of Barcelona, Department of Internal Medicine, Bellvitge Hospital, Barcelona, Spain.
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Yamamoto T, Nagira K, Akisue T, Marui T, Hitora T, Nakatani T, Kurosaka M, Tsukamoto R. Aspiration biopsy of nodular sarcoidosis of the muscle. Diagn Cytopathol 2002; 26:109-12. [PMID: 11813329 DOI: 10.1002/dc.10055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The nodular form of muscular sarcoidosis is rare and the condition is often confused with a soft tissue neoplasm. We present a case of nodular muscular sarcoidosis of the right calf in a 52-yr-old woman which was diagnosed by thin-needle aspiration biopsy (TNAB). In this patient, a calf mass was the initial manifestation of sarcoidosis. Contrast-enhanced computed tomographic scans of the calf showed a mass with peripheral ring-like enhancement. T2-weighted magnetic resonance images demonstrated a mass with central hypointensity and marked peripheral hyperintensity. TNAB revealed noncaseating epithelioid cell granulomas in association with multinucleated giant cells. Combined with the radiologic findings, TNAB is considered a useful modality for the diagnosis of nodular muscular sarcoidosis.
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Affiliation(s)
- Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan.
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Affiliation(s)
- J R Bell
- Department of Radiology, Kent and Canterbury Hospital, Canterbury CT1 3NG, UK
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