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Nuclear Medicine
Thoracic
Infection and Inflammation
Granulomatous Disease
Granulomatous Disease
Bhavana Budigi, MD; Todd Michael Danziger, MD; Hollins Clark, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      TERMINOLOGY

      • Definitions

        • Disease characterized by formation of granulomas, either infectious or noninfectious
          • Sarcoidosis, mycobacterial infections, hypersensitivity pneumonitis, Langerhans cell histiocytosis, granulomatosis with polyangiitis, chronic granulomatous disease

      IMAGING

      • General Features

        • Nuclear Medicine Findings

          • Radiographic Findings

            • Imaging Recommendations

              • CT Findings

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • Microscopic Features

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Image Interpretation Pearls

                              Selected References

                              1. Pabón L et al: Role of 18F-FDG PET/CT in the diagnostic challenge of sarcoidosis. Rev Esp Med Nucl Imagen Mol. 38(5):322-4, 2019
                              2. Papiris SA et al: 18F-FDG PET/CT in pulmonary sarcoidosis:Quantifying inflammation by the TLG index. Expert Rev Respir Med. 1-8, 2019
                              3. Akaike G et al: PET/CT in the diagnosis and workup of sarcoidosis: Focus on atypical manifestations. Radiographics. 38(5):1536-49, 2018
                              4. Larici AR et al: Radiological and nuclear medicine imaging of sarcoidosis. Q J Nucl Med Mol Imaging. 62(1):14-33, 2018
                              5. Malinowska E et al: The use of 67Ga scintigraphy in patients with sarcoidosis. Nucl Med Rev Cent East Eur. 21(1):59-65, 2018
                              6. Albano D et al: Role of 18F-FDG PET/CT in patients affected by Langerhans cell histiocytosis. Jpn J Radiol. 35(10):574-83, 2017
                              7. Ankrah AO et al: PET/CT imaging of Mycobacterium tuberculosis infection. Clin Transl Imaging. 4:131-44, 2016
                              8. Skoura E et al: Imaging in tuberculosis. Int J Infect Dis. 32:87-93, 2015
                              9. Society of Nuclear Medicine. Procedure Guideline for Gallium Scintigraphy in Inflammation, Version 3.0. http://snmmi.files.cms-plus.com/docs/Gallium_Scintigraphy_in_Inflammation_v3.pdf. Approved June 2, 2004. Accessed August 3, 2015
                              10. Baughman RP et al: Medical therapy of sarcoidosis. Semin Respir Crit Care Med. 35(3):391-406, 2014
                              11. Castañer E et al: Imaging findings in pulmonary vasculitis. Semin Ultrasound CT MR. 33(6):567-79, 2012
                              12. Oksüz MO et al: 18F-FDG PET/CT for the diagnosis of sarcoidosis in a patient with bilateral inflammatory involvement of the parotid and lacrimal glands (panda sign) and bilateral hilar and mediastinal lymphadenopathy (lambda sign). Eur J Nucl Med Mol Imaging. 38(3):603, 2011
                              13. Chung SY et al: 18F-FDG PET imaging of progressive massive fibrosis. Ann Nucl Med. 24(1):21-7, 2010
                              14. Criado E et al: Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics. 30(6):1567-86, 2010
                              15. Hirschmann JV et al: Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics. 29(7):1921-38, 2009
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Imaging

                                • Top Differential Diagnoses

                                  TERMINOLOGY

                                  • Definitions

                                    • Disease characterized by formation of granulomas, either infectious or noninfectious
                                      • Sarcoidosis, mycobacterial infections, hypersensitivity pneumonitis, Langerhans cell histiocytosis, granulomatosis with polyangiitis, chronic granulomatous disease

                                  IMAGING

                                  • General Features

                                    • Nuclear Medicine Findings

                                      • Radiographic Findings

                                        • Imaging Recommendations

                                          • CT Findings

                                            DIFFERENTIAL DIAGNOSIS

                                              PATHOLOGY

                                              • Microscopic Features

                                                CLINICAL ISSUES

                                                • Presentation

                                                  • Demographics

                                                    • Natural History & Prognosis

                                                      • Treatment

                                                        DIAGNOSTIC CHECKLIST

                                                        • Image Interpretation Pearls

                                                          Selected References

                                                          1. Pabón L et al: Role of 18F-FDG PET/CT in the diagnostic challenge of sarcoidosis. Rev Esp Med Nucl Imagen Mol. 38(5):322-4, 2019
                                                          2. Papiris SA et al: 18F-FDG PET/CT in pulmonary sarcoidosis:Quantifying inflammation by the TLG index. Expert Rev Respir Med. 1-8, 2019
                                                          3. Akaike G et al: PET/CT in the diagnosis and workup of sarcoidosis: Focus on atypical manifestations. Radiographics. 38(5):1536-49, 2018
                                                          4. Larici AR et al: Radiological and nuclear medicine imaging of sarcoidosis. Q J Nucl Med Mol Imaging. 62(1):14-33, 2018
                                                          5. Malinowska E et al: The use of 67Ga scintigraphy in patients with sarcoidosis. Nucl Med Rev Cent East Eur. 21(1):59-65, 2018
                                                          6. Albano D et al: Role of 18F-FDG PET/CT in patients affected by Langerhans cell histiocytosis. Jpn J Radiol. 35(10):574-83, 2017
                                                          7. Ankrah AO et al: PET/CT imaging of Mycobacterium tuberculosis infection. Clin Transl Imaging. 4:131-44, 2016
                                                          8. Skoura E et al: Imaging in tuberculosis. Int J Infect Dis. 32:87-93, 2015
                                                          9. Society of Nuclear Medicine. Procedure Guideline for Gallium Scintigraphy in Inflammation, Version 3.0. http://snmmi.files.cms-plus.com/docs/Gallium_Scintigraphy_in_Inflammation_v3.pdf. Approved June 2, 2004. Accessed August 3, 2015
                                                          10. Baughman RP et al: Medical therapy of sarcoidosis. Semin Respir Crit Care Med. 35(3):391-406, 2014
                                                          11. Castañer E et al: Imaging findings in pulmonary vasculitis. Semin Ultrasound CT MR. 33(6):567-79, 2012
                                                          12. Oksüz MO et al: 18F-FDG PET/CT for the diagnosis of sarcoidosis in a patient with bilateral inflammatory involvement of the parotid and lacrimal glands (panda sign) and bilateral hilar and mediastinal lymphadenopathy (lambda sign). Eur J Nucl Med Mol Imaging. 38(3):603, 2011
                                                          13. Chung SY et al: 18F-FDG PET imaging of progressive massive fibrosis. Ann Nucl Med. 24(1):21-7, 2010
                                                          14. Criado E et al: Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics. 30(6):1567-86, 2010
                                                          15. Hirschmann JV et al: Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics. 29(7):1921-38, 2009